Evaluation of Guidelines for Surgical Management of Urolithiasis

Many urological societies have provided evidence-based guidelines to help the urologist make therapeutic choices. However, the recommendations in these guidelines may be heterogeneous because they were developed using various methods. The objective of this study was to review key guidelines on the surgical management of urinary stones to provide practical guidance for clinical application.

Guidelines on urolithiasis from all international urological societies were searched through the society websites. A search on PubMed® and Medline® restricted to publications in English was also performed for guidelines published between January 1, 2010 and July 1, 2017. Only the latest versions of guidelines containing an evaluation of the level of evidence and the grade of recommendation were included in the final analysis. All recommendations on surgical stone management and recommended techniques for each surgical modality were included. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to assess the quality of the included guidelines.

Three international guidelines were included in analysis, including those of AUA (American Urological Association)/ES (Endourological Society), EAU (European Association of Urology) and SIU (Société Internationale d'Urologie)/ICUD (International Consultation on Urological Diseases). We highlighted the heterogeneity in the level of evidence and the grade of recommendation which arose due to the different methods of evaluations that had been adopted. Despite this our review highlighted the considerable similarities among the guidelines. In certain specific situations for which no good evidence was available the recommendations could only be based on expert opinion.

An option to provide clear guidance to the urologist might be to combine these international guidelines into one to reduce confusion about the surgical management of urolithiasis.