Primary Urethral Carcinoma

2. METHODS

2.1. Data identification

For the 2023 Primary Urethral Carcinoma Guidelines, new and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature. An updated systematic literature search was performed to identify studies reporting data on urethral malignancies since the prior search, covering a time frame between July 14^th 2021 and August 8^th 2022. Databases searched included Ovid (Medline), EMBASE and the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. A total of 122 unique records were identified, retrieved, and screened for relevance. Five new references were included in this 2023 publication. A detailed search strategy is available online: https://uroweb.org/guidelines/primary-urethral-carcinoma/publications-appendices.

For each recommendation within the guidelines there is an accompanying online strength rating form which includes the 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 [4,5]. These forms address 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 [6];
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’ [7]. 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. The strength rating forms will be available online.

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

This document was peer-reviewed prior to publication in 2021.