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Surgical management of urolithiasis – a systematic analysis of available guidelines.

Surgical management of urolithiasis – a systematic analysis of available guidelines.
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Zumstein V, Betschart P, Abt D, Schmid HP, Panje CM, Putora PM,


Zumstein V, Betschart P, Abt D, Schmid HP, Panje CM, Putora PM, (click to view)

Zumstein V, Betschart P, Abt D, Schmid HP, Panje CM, Putora PM,

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BMC urology 2018 04 1018(1) 25 doi 10.1186/s12894-018-0332-9

Abstract
BACKGROUND
Several societies around the world issue guidelines incorporating the latest evidence. However, even the most commonly cited guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA) leave the clinician with several treatment options and differ on specific points. We aimed to identify discrepancies and areas of consensus between guidelines to give novel insights into areas where low consensus between the guideline panels exists, and therefore where more evidence might increase consensus.

METHODS
The webpages of the 61 members of the Societ√© Internationale d’Urologie were analysed to identify all listed or linked guidelines. Decision trees for the surgical management of urolithiasis were derived, and a comparative analysis was performed to determine consensus and discrepancies.

RESULTS
Five national and one international guideline (EAU) on surgical stone treatment were available for analysis. While 7 national urological societies refer to the AUA guidelines and 11 to the EAU guidelines, 43 neither publish their own guidelines nor refer to others. Comparative analysis revealed a high degree of consensus for most renal and ureteral stone scenarios. Nevertheless, we also identified a variety of discrepancies between the different guidelines, the largest being the approach to the treatment of proximal ureteral calculi and larger renal calculi.

CONCLUSIONS
Six guidelines with recommendations for the surgical treatment of urolithiasis to support urologists in decision-making were available for inclusion in our analysis. While there is a high grade of consensus for most stone scenarios, we also detected some discrepancies between different guidelines. These are, however, controversial situations where adequate evidence to assist with decision-making has yet to be elicited by further research.

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