2. METHODS
2.1. Evidence sources
For the 2023 Urological Trauma Guidelines, 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 Urological Trauma Guidelines was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries, covering a time frame between May 1st, 2021, and April 29th, 2022. A total of 1,236 unique records were identified, retrieved and screened for relevance. A detailed search strategy is available online: http://uroweb.org/guideline/urological-trauma/?type=appendices-publications. The majority of identified publications were comprised of case reports and retrospective case series. The lack of high-powered randomised controlled trials (RCTs) makes it difficult to draw meaningful conclusions. The panel recognises this critical limitation.
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 draws on the guiding principles of the GRADE methodology but do not purport to be GRADE [6,7]. Each strength rating form addresses several 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 [8];
- 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’ [9]. 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. Peer review
The Urological trauma Guidelines was peer reviewed prior to publication in 2019.