For the 2018 edition of the EAU Neuro-Urology Guidelines the Guidelines Office have transitioned to a modified GRADE methodology. For each recommendation within the guidelines there is an accompanying online strength rating form which addresses a number of key elements namely:
- the overall quality of the evidence which exists for the recommendation;
- 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 determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence, and nature and variability of patient values and preferences. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’.
In addition, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the Neuro-Urology Guidelines was performed. Twenty one dditional references and text updates have been incorporated throughout the text as a result of this search. Furthermore, all recommendations have been rephrased throughout the current document to aid in their implementation.