Urological Infections

2. METHODS

2.1. Introduction

For the 2023 Urological Infections Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for sections 3.5 Recurrent UTI, 3.16.2.8 Peri-Procedural Antibiotic Prophylaxis - Prostate Biopsy and the newly added section 3.15 Genitourinary Tuberculosis. Broad and comprehensive literature searches, covering these sections were performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. The time frames covered and the number of unique records identified, retrieved and screened for relevance for each section were:

Detailed search strategies are available online: https://uroweb.org/guidelines/urological-infections/publications-appendices.

For each recommendation within the guidelines there is an accompanying line strength rating form which includes an assessment of the benefit to harms ratio and patients’ preferences for each recommendation. The strength rating forms draw on the guiding principles of the GRADE methodology but do not purport to be GRADE [3]. Each strength rating form addresses several key elements namely:

1. the overall quality of the evidence which exists for the recommendation, references used in this text are graded according to a classification system modified from the Oxford Centre for Evidence-Based Medicine Levels of Evidence [4];
2. the magnitude of the effect (individual or combined effects);
3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
4. the balance between desirable and undesirable outcomes;
5. the impact of patient values and preferences on the intervention;
6. 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 represented by the words ‘strong’ or ‘weak’ [5]. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and nature and variability of patient values and preferences.

Additional information can be found in the general Methodology section of this print, and on the EAU website; http://www.uroweb.org/guideline/. A list of associations endorsing the EAU Guidelines can also be viewed online at the above address.

2.2. Review

This document was subject to independent peer review prior to publication in 2019.