Guidelines

Urolithiasis

2. METHODS

2.1. Data identification

For the 2022 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 1st May 2020 and 12th May 2021. A total of 737 unique records were identified and screened for relevance.

For the 2022 Bladder Stones section, new and relevant evidence was identified, collated, and appraised through a structured assessment of the literature. The search was limited to studies representing high levels of evidence only published in the English language. The search was restricted to articles published between April 2020 and April 2021. A total of 235 unique records were identified and screened for relevance.

In addition to this, several ancillary searches limited to studies representing high levels of evidence only and published in the English language were also carried out to underpin the new chapter 3.5. radiation exposure and protection during endourology, and to formulate best clinical practice statements. The five-year search, from 2016 to May 2021, on radiation exposure and urolithiasis returned a total of 117 unique records which were identified and screened for relevance. The remainder of the searches on specific interventions that could be used to formulate best clinical practice statements returned a total of 1,080 records which were identified and screened for relevance. These include a four-year search (2018-2021) on URS thulium fiber laser; five-year searches (2017-2021) on URS internal temperature, URS suction with fragmentation, URS intrarenal pressure, fluoroless URS, PNL suction, and PNL fluoroless; a six-year search (2016-2021) on single vs. reusable URS, and ten-year searches (2011-2021) on SWL, URS fibreoptic vs. digital, optimal laser, URS time limit operation, PNL anaesthesia, PNL thermal and PNL renal puncture.

Databases covered by the searches included Medline, EMBASE, Ovid and the Cochrane Libraries. The search strategies are published online: http://uroweb.org/guideline/urolithiasis/?type=appendices-publications.

A total of 59 new references have been added to the 2022 Urolithiasis Guidelines publication.

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, the basis of which is a modified GRADE methodology [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 2023 text update the Urolithiasis Guidelines Panel aim to provide further guidance on the following topics:

  • Further evaluate the highest evidence for best clinical practice in endourology.
  • Perform a systematic review on patient and personnel radiation protection during endourology.
  • Questioning the accuracy of stone size as the surrogate index for deciding upon the treatment of urinary stones.