For the 2018 edition of the EAU Male LUTS Guidelines the Guidelines Office have transitioned to a modified GRADE methodology. For each recommendation within the guidelines there is an accompanying online strength rating form which addresses a number of key elements namely:

the overall quality of the evidence which exists for the recommendation;
the magnitude of the effect (individual or combined effects);
the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
the balance between desirable and undesirable outcomes;
the impact of patient values and preferences on the intervention;
the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence, and nature and variability of patient values and preferences. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’. All recommendations have been rephrased throughout the current document to aid in their implementation.

In addition, a summary of the results of the Panels’ systematic review on ‘The risk of tumour recurrence in patients undergoing renal transplantation for end-stage renal disease after previous treatment for a urological cancer’ has been included in section 2.2 of the Guidelines.