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 . Each strength rating form addresses a number of key elements namely:
- 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 ;
- 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 represented by the words ‘strong’ or ‘weak’ . 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.
The 2012 full text update was based on a systematic review (SR) of literature using the Embase and Medline databases, the Cochrane Central Register of controlled trials and the PsycINFO and Bandolier databases to identify the best evidence from randomised controlled trials (RCTs) (Level of Evidence 1 [LE: 1]) according to the rating schedule adapted from the Oxford Centre for Evidence-based Medicine Levels of Evidence. Where no LE: 1 literature could be identified the search was moved down to the next lower level on the rating scale.
Extensive use of free text ensured the sensitivity of the searches, resulting in a substantial body of literature to scan. Searches covered the period January 1995 to July 2011 and were restricted to English language publications. In 2017, a scoping search for the previous five years was performed and the guideline was updated accordingly.
In 2021, a new section was included on Post-Surgical Pain Syndrome. In addition, the classifications in the Guideline have been amended to reflect ICD-11 released by WHO. The latest version of ICD-11 will be available for member states to report with as from January 2022. For the 2022 print, a scoping search for the previous three years was performed and the guideline was updated accordingly.
This document was subject to peer review prior to publication in 2021.