Research Article: Online Discussion on #KidneyStones: A Longitudinal Assessment of Activity, Users and Content

Date Published: August 18, 2016

Publisher: Public Library of Science

Author(s): Johannes Salem, Hendrik Borgmann, Matthew Bultitude, Hans-Martin Fritsche, Axel Haferkamp, Axel Heidenreich, Arkadiusz Miernik, Andreas Neisius, Thomas Knoll, Christian Thomas, Igor Tsaur, Jeff M Sands.


Twitter is a popular microblogging platform for the rapid dissemination of information and reciprocal exchange in the urological field. We aimed to assess the activity, users and content of the online discussion, #KidneyStones, on Twitter.

We investigated the Symplur Signals analytics tool for Twitter data distributed via the #KidneyStones hashtag over a one year period. Activity analysis reflected overall activity and tweet enhancements. We assessed users’ geolocations and performed an influencer analysis. Content analysis included the most frequently used words, tweet sentiment and shares for top tweets.

3,426 users generated over 10,333 tweets, which were frequently accompanied by links (49%), mentions (30%) and photos (13%). Users came from 106 countries across the globe and were most frequently from North America (63%) and Europe (16%). Individual and organisational healthcare professionals made up 56% of the influencers of the Twitter discussion on #KidneyStones. Besides the words ‘kidney’ (used 4,045 times) and ‘stones’ (3,335), ‘pain’ (1,233), ‘urine’ (1,158), and ‘risk’ (1,023) were the most frequently used words. 56% of tweets had a positive sentiment. The median (range) number of shares was 85 (62–587) for the top 10 links, 45.5 (17–94) for the top 10 photos, and 44 (22–95) for the top 10 retweets.

The rapidly growing Twitter discussion on #KidneyStones engaged multiple stakeholders in the healthcare sector on a global scale and reached both professionals and laypeople. When used effectively and responsibly, the Twitter platform could improve prevention and medical care of kidney stone patients.

Partial Text

The microblogging social media platform, Twitter, enjoys increasing popularity in the healthcare sector. Currently, over 70% of urologists in Australia and New Zealand have a social media presence, with Twitter being the second most commonly used form after LinkedIn, which serves a completely different purpose [1]. Urologists using Twitter during the European Association of Urology (EAU) and the American Urological Association (AUA) congresses regarded it as beneficial for professional networking, disseminating information, research, advocacy, and career development [2]. Impressively, 1,860 users generated 15,419 tweets in total at the EAU14 and AUA14 congresses [3]. Notably, the Twitter-based International Urology Journal Club, #urojc, has established a high-level academic discussion of urologic manuscripts [4]. In attempt to standardise the online discussion about urological care, a particular structuring of the key urology-related hashtags has recently been proposed [5]. Interestingly, the high technology field of endourology was the first urologic subspeciality assessed for Twitter activity during the 2013 World Congress of Endourology [6]. Most recently, a Twitter discussion during the Third Meeting of the European Association of Urology Section of Urolithiasis 2015 comprised 94 users contributing 446 tweets [7].

The study was approved by the Ethics Commission of the Faculty of Medicine of the University of Cologne. We performed an extensive analysis of activity, users and content of the online discussion on #KidneyStones on Twitter, using the Symplur Signals database. Symplur ( is a Twitter analysis website that maintains a database of healthcare-related Twitter conversations. Symplur Signals ( is a fee-based research analytics tool that promotes the understanding of healthcare as seen by patients, doctors and other stakeholders with access to healthcare social media data points.

Table 1 shows overall activity for the #KidneyStones online discussion on Twitter for the time period of one year. 3,426 users produced 10,806 tweets. Fig 1 portrays the weekly number of tweets on #KidneyStones, which slightly increased over the investigated time period. The peak tweet activity occurred during a strategic massive tweet activity of key influencers, evoking a large amount of retweets (influencers: @virtualclinicng, 9th March 2015 and 11th March 2015, 41 tweets on kidney stones prevention leading to a peak of over 500 tweets in a week; @mayoclinic, 11th July 2015, 41 tweets on kidney stones prevention during a radio show leading to a peak of over 400 tweets in a week).

We performed a longitudinal assessment of activity, users and content of the online discussion on #KidneyStones, using the Symplur Signals health analytics database. Over the one year period, Twitter activity was reflected by 10,806 tweets, which were frequently enhanced with links and mentions, and were posted predominantly in English. Together, 3,426 users from 106 countries contributed to the online discussion, with non-professional individuals and healthcare organisations being the main influencers. Content was dominated by the words ‘kidney’, ‘stones’, ‘pain’, ‘urine’ and ‘risk’, and tweets had more positive than negative sentiments. The top links, photos and retweets were shared up to 100 times.

The Twitter discussion on #KidneyStones engaged multiple stakeholders in the healthcare sector on a global scale and involves both professionals and laypeople. Considering the rapidly increasing prevalence and treatment-related costs of urolithiasis, Twitter might promote shared decision-making and contribute to the optimisation of patient care.