Urolithiasis

2. METHODS

2.1. Data identification

For the 2023 Urolithiasis Guidelines, new and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature.

A broad and comprehensive scoping exercise covering all areas of the guideline was performed. The search was limited to studies representing high levels of evidence only (i.e., systematic reviews with meta-analysis (MA), randomised controlled trials (RCTs), and prospective non-randomised comparative studies) published in the English language. The search was restricted to articles published between 1^st May 2021 and 9^th May 2022. A total of 635 unique records were identified and screened for relevance. A total of 66 new references have been added to the Urolithiasis 2023 Guidelines publication.

Databases covered by the searches included Medline, EMBASE, Ovid and the Cochrane Libraries. The search strategy is published online: https://uroweb.org/guidelines/urolithiasis/ publications-appendices. The chapters on the treatment of bladder stones in adults and children are based on a systematic review [4].

For each recommendation within the guidelines there is an accompanying online 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 [5,6]. Each strength-rating form addresses a number of 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 [7];
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’ [8]. 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 online at 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

The 2015 Urolithiasis Guidelines were subjected to peer-review prior to publication. Chapter 6, detailing the treatment and follow-up of bladder stones was peer reviewed in 2019.

2.3. Future goals

For the 2024 text update the Urolithiasis Guidelines Panel aim to:

• Further evaluate the highest evidence for best clinical practice in endourology.
• Question the accuracy of stone size as the surrogate index on deciding the appropriate treatment of urinary stones.
• Complete two systematic reviews on:

a) The relation of kidney stones and their treatment on chronic kidney failure and end stage kidney disease.

b) Patient and personnel radiation protection during endourology.