Department of Urology, University of California, Los Angeles, Los Angeles, CA, United States.
Department of Urology, Stanford University, Palo Alto, CA, United States.
JMIR Form Res. 2024 Oct 10;8:e50141. doi: 10.2196/50141.
Varicoceles affect up to 30% of postpubertal adolescent males. Studying this population remains difficult due to this topic's sensitive nature. Using the popularity of social media in this cohort and natural language processing (NLP) techniques, our aim was to identify perceptions of adolescent males on an internet varicocele forum to inform how physicians may better evaluate and counsel this pediatric population.
We aimed to characterize themes of discussion and specific concerns expressed by adolescents using a mixed methods approach involving quantitative NLP and qualitative annotation of an online varicocele community.
We extracted posts from the Reddit community "r/varicocele" (5100 members) with criteria of discussant age ≤21 years and word count >20. We used qualitative thematic analysis and the validated constant comparative method, as well as an NLP technique called the meaning extraction method with principal component analysis (MEM/PCA), to identify discussion themes. Two investigators independently interrogated 150 randomly selected posts to further characterize content based on NLP-identified themes and calculated the Kaiser-Meyer-Olkin (KMO) statistic and the Bartlett test. Both quantitative and qualitative approaches were then compared to identify key themes of discussion.
A total of 1103 posts met eligibility criteria from July 2015 to June 2022. Among the 150 randomly selected posts, MEM/PCA and qualitative thematic analysis separately revealed key themes: an overview of varicocele (40/150, 27%), management (29/150, 19%), postprocedural experience (28/150, 19%), seeking community (26/150, 17%) and second opinions after visiting a physician (27/150, 18%). Quantitative analysis also identified "hypogonadism" and "semen analysis" as concerns when discussing their condition. The KMO statistic was >0.60 and the Bartlett test was <0.01, indicating the appropriateness of MEM/PCA. The mean age was 17.5 (SD 2.2; range 14-21) years, and there were trends toward higher-grade (40/45, 89% had a grade of ≥2) and left-sided varicoceles. Urologists were the topic of over 50% (53/82) of discussions among discussants, and varicocelectomy remained the intervention receiving the most interest. A total of 60% (90/150) of discussants described symptomatic varicoceles, with 62 of 90 reporting pain, 24 of 90 reporting hypogonadism symptoms, and 45 of 90 reporting aesthetics as the primary concern.
We applied a mixed methods approach to identify uncensored concerns of adolescents with varicoceles. Both qualitative and quantitative approaches identified that adolescents often turned to social media as an adjunct to doctors' visits and to seek peer support. This population prioritized symptom control, with an emphasis on pain, aesthetics, sexual function, and hypogonadism. These data highlight how each adolescent may approach varicoceles uniquely, informing urologists how to better interface with this pediatric population. Additionally, these data may highlight the key drivers of decision-making when electing for procedural management of varicoceles.
精索静脉曲张影响多达 30%的青春期后男性。由于该主题的敏感性，研究这一人群仍然具有挑战性。本研究旨在利用该队列中社交媒体的普及和自然语言处理（NLP）技术，确定青少年对互联网精索静脉曲张论坛的看法，以告知医生如何更好地评估和咨询这一儿科人群。
我们旨在通过混合方法（包括定量 NLP 和在线精索静脉曲张社区的定性注释）来描述青少年讨论的主题和具体关注点。
我们从 Reddit 社区“r/varicocele”（5100 名成员）中提取了年龄≤21 岁且字数>20 的讨论者的帖子。我们使用定性主题分析和经过验证的恒比法，以及称为意义提取方法与主成分分析（MEM/PCA）的 NLP 技术，来识别讨论主题。两名研究人员独立检查了 150 个随机选择的帖子，根据 NLP 识别出的主题进一步描述内容，并计算 Kaiser-Meyer-Olkin（KMO）统计量和 Bartlett 检验。然后比较定量和定性方法，以确定讨论的关键主题。
2015 年 7 月至 2022 年 6 月期间，共有 1103 个帖子符合入选标准。在 150 个随机选择的帖子中，MEM/PCA 和定性主题分析分别揭示了关键主题：精索静脉曲张概述（40/150，27%）、管理（29/150，19%）、术后体验（28/150，19%）、寻求社区（26/150，17%）和在看医生后寻求第二意见（27/150，18%）。定量分析还确定了“性腺功能减退症”和“精液分析”是讨论其病情时的关注点。KMO 统计量>0.60，Bartlett 检验<0.01，表明 MEM/PCA 是合适的。平均年龄为 17.5（SD 2.2；范围 14-21）岁，存在较高等级（40/45，89%为≥2 级）和左侧精索静脉曲张的趋势。泌尿科医生是讨论者中超过 50%（53/82）讨论的话题，精索静脉切除术仍然是最受关注的干预措施。共有 60%（90/150）的讨论者描述了有症状的精索静脉曲张，其中 62/90 报告了疼痛，24/90 报告了性腺功能减退症症状，45/90 报告了美观是主要关注点。
我们应用混合方法来确定精索静脉曲张青少年未被审查的关注点。定性和定量方法都确定，青少年经常转向社交媒体作为医生就诊的辅助手段，并寻求同伴支持。该人群优先考虑症状控制，重点是疼痛、美观、性功能和性腺功能减退症。这些数据突出了每个青少年可能如何独特地处理精索静脉曲张，告知泌尿科医生如何更好地与这一儿科人群接触。此外，这些数据可能突出了选择精索静脉曲张手术管理时决策的关键驱动因素。
