During the recent EAU Annual Congress in Vienna the Chronic Pelvic Pain guideline panel chaired by professor Daniel Engeler organised a discussion centered on identifying the literature and building the CPP evidence base. All agreed that if the search is not solid the base may crumble.
For its new CPP guideline update the panel wants to move from level 4 evidence (expert opinion) to level 1 evidence based on a systematic review of the available literature. Because this is the paradox: you are the expert – you have all evidence in your head but this remains evidence level 4 unless it is reproduced/verified by an independent and systematic review of the literature.
Group discussion with the information scientist on sensitivity and precision soon showed the impracticalities associated with a highly sensitive ‘Cochrane like’ CPP search strategy in the Cochrane Library, Embase and Medline. Instead, it was decided to break the topic down into separate searches for pelvic pain, scrotal pain , bladder pain , prostate pain, urethral pain and so on – searches would collect evidence per chapter.
Following on from this group discussion, panel members will formulate ‘answerable questions (‘searchable questions’!) using a PICO approach (Patients- Intervention –Comparison – Outcome) for all separate CPP chapters and agree on inclusion and exclusion criteria for the search.
A careful assembly of the search strategy requires a full understanding between the searcher and the urologist – this will make for a good search and the base will stand solid.
Drs. J.H. Krabshuis
Highland Data – France