青少年精索静脉曲张患者和家庭经历的定性研究:生育能力、自尊和性功能的重点。

IF 2 3区 医学 Q2 PEDIATRICS Journal of Pediatric Urology Pub Date : 2024-11-14 DOI:10.1016/j.jpurol.2024.11.005
Grace E Sollender, Eduardo Piqueiras, Allen E D Siapno, Thiago P Furtado, Ilana Finkelshtein, Jennifer S Singer, Sriram V Eleswarapu
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引用次数: 0

摘要

背景:精索静脉曲张是阴囊内静脉丛的异常扩张,常见于青春期后的男性。这种情况与男性不育、睾丸萎缩和疼痛有关。然而,青少年患者及其家属在精索静脉曲张的评估、监测和管理方面的临床经验尚未得到研究。目的:探讨精索静脉曲张诊断及后续处理的患者及家属经验,以更好地了解影响决策和护理的重要因素。方法:我们于2022年8月至2023年1月对患者及其家属进行了半结构化访谈。共有39名参与者(16名青少年男性和23名父母)在加州一家城市三级护理医院接受精索静脉曲张诊断和治疗后被招募。采用有目的抽样,通过医疗记录筛选来确定参与者的资格。通过使用不断比较和备忘录写作,利用改进的扎根理论方法,分析包括开放编码,轴向编码和选择性编码,从而产生核心概念和类别。结果:结果表明,家长和青少年在青少年精索静脉曲张的诊断和治疗过程中,可以从提高对长期期望的理解和教育中受益。定性分析表明:1)父母和青少年对生育有共同的担忧;然而,由于医疗决策的复杂性依赖于青少年和父母对精索静脉曲张影响和结果的全面理解,这加剧了这种情况。2)精索静脉曲张对青少年自尊和性功能的心理社会影响是寻求治疗的重要驱动因素,这通常表现在通过“男子气概”概念和未来性表现来讨论男性气概。讨论:与患者和家属的讨论主要集中在他们对生育、性功能和美学(影响自尊)的担忧;然而,他们主要关心的是需要更准确和全面的信息,其中包括病情的自然历史和治疗方案的全部范围。未来的研究应该检查来自不同背景和地理位置的患者和家庭的经验,以确定经验的潜在差异。结论:研究结果表明,儿科泌尿科医生和家属之间的沟通需要得到潜在的改善,以减轻患者和家属之间的焦虑和不确定性,并使他们能够对自己的护理做出明智的决定。
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A qualitative study of patient and family experiences in adolescents with varicoceles: A focus on fertility, self-esteem, and sexual function.

Background: A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum that commonly affects postpubertal males. The condition has been associated with male infertility, testicular hypotrophy, and pain. However, the clinical experiences of adolescent patients and their families regarding the evaluation, surveillance, and management of varicoceles have not been previously examined.

Objective: This study explores the patient's and family's experiences of varicocele diagnosis and subsequent management to better understand the salient factors impacting decision-making and care.

Methods: We conducted semi-structured interviews with patients and their families between August 2022 and January 2023. A total of 39 participants (16 adolescent males and 23 parents) were recruited following varicocele diagnosis and treatment at an urban, tertiary care hospital in California. Purposive sampling was adopted for the recruitment of participants through medical record screening to identify eligibility. Utilizing a modified grounded theory approach through the use of constant comparison and memo writing, the analysis consisted of open coding, axial coding, and selective coding, resulting in the production of core concepts and categories.

Results: Results demonstrate that parents and adolescents can benefit from improved understanding and education about long-term expectations during the diagnosis and treatment of adolescent varicoceles. Qualitative analysis indicates: 1) parents and adolescents have common concerns regarding fertility; however, this is exacerbated by the complexity of medical decision-making being dependent on adolescent and parental understanding of the full scope of varicocele impacts and outcomes, and 2) the psychosocial impact of a varicocele on adolescent self-esteem and sexual function are significant drivers for seeking care, which often manifested through discussions on masculinity through notions of 'manhood' and future sexual performance.

Discussion: Discussions with patients and families largely focused on their concerns regarding fertility, sexual function, and aesthetics (impacting self-esteem); however, their primary concern was for the need for more accurate and comprehensive information, which includes the natural history of the condition and the full scope of treatment options. Future studies should examine the experiences of patients and families from diverse backgrounds and geographic locations to identify potential differences in experiences.

Conclusion: Findings identified the need for potential improvement in communication between pediatric urologists and families to alleviate anxiety and uncertainty among patients and families and empower them to make informed decisions about their care.

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来源期刊
Journal of Pediatric Urology
Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY
CiteScore
3.70
自引率
15.00%
发文量
330
审稿时长
4-8 weeks
期刊介绍: The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review. It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty. It publishes regular reviews of pediatric urological articles appearing in other journals. It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty. It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
期刊最新文献
Letter to the editors on "International consensus on research priorities in hypospadias using a Delphi study approach". The influence of positive and negative intraoperative feedback in laparoscopic simulation in pediatric urology training. Alkaline urine is associated with increased risk of calcium phosphate nephrolithiasis in medically complex children receiving enteral nutrition. The utilization of a spare ureter to create a continent catheterizable channel to the bladder in pediatric patients. Response to the editorial commentary on 'When you cannot trust what you see: The confounding effect'.
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