The premier journals in our field continue to be those managed by the 2 largest professional societies, the AUA (The Journal of Urology^® [JU]) and the European Association of Urology (European Urology [EU]). Getting papers accepted in these journals is no easy task. In 2022, there were 1,453 manuscripts submitted to the Adult Urology section of JU, of which only 10% were accepted for publication. Against this background, how can an investigator increase their chances of getting a paper peer reviewed, or even accepted, in a high-impact journal? It was with this motivation in mind, to help authors understand the schema for writing high-quality papers, that a joint JU-EU writing course at the 38th Annual European Association of Urology Congress in Milan was held. In this article we provide an overview of the course (see Table), and some key takeaways.

Table. Content and Speakers of First The Journal of Urology^®–European Urology Writing Course

How to Write the Introduction and Methods

Dr Psutka gave an excellent lecture about the importance of checklists for reporting studies, especially randomized clinical trials. In this regard, the CONSORT guidelines is essential reading, even when conducting nonrandomized trials.¹ The 3 foundations of an introduction, which should be no more than 2 or 3 paragraphs with a maximum of 500 words, were emphasized: (1) Provide background data for your study; (2) Identify the knowledge gap and its significance; (3) State your study objective, with the hypotheses tested. Course tutors agreed that getting the introduction right, can often be the hardest part of a manuscript, as this is where the unmet need of the study is articulated.

For the Methods, Dr Psutka spoke about keeping it clear, concise and simple, and ask the question, could someone else replicate your study and get the same results? Sequential steps for writing include how the cohort is defined, the independent variable of interest, the outcome of interest, and how the analysis was performed. There are multiple sources of guidance for methodology, and authors are strongly encouraged to follow these for systematic review (PRISMA),² observational cohort study (STROBE),³ patient-reported outcome measures (COSMIN),⁴ survey studies (CROSS),⁵ and evaluation of surgical innovation (IDEAL).⁶

Statistics

Two very important documents when writing a manuscript were highlighted by Dr Vickers. These were “Guidelines for Reporting of Statistics for Clinical Research in Urology”⁷ and “Guidelines for Reporting of Figures and Tables for Clinical Research in Urology.”⁸ All the tutors agreed they were essential reading. Dr Vickers is an eloquent speaker, and it will not be possible to repeat his statistical nuggets in this article related to P values, null hypotheses, statistical tests, and the difference between causality and association, as it will not do it justice! However, one of his main takeaway pieces of advice is for us to be more thoughtful in our handling of statistical inference and estimation of effect, as well as its reporting. Although the above references are a goldmine, our advice is to consult with a biostatistician early, before the data are collected and the paper is written.

How to Write the Results and Discussion

The Results section should mirror the Methods. It describes in simple terms what the data show, and trends observed. It is important to avoid duplicating results, in both text and figures/tables. The prose should contextualize the results, not just restate it. Tables and figures should be additive, and tell a story on their own. Legends should be written in a manner so that the reader can understand the significance of a table/figure without reading the manuscript.

Now that all the hard work has been done, the Discussion can sometimes be the easiest section to write, especially if one follows 5 thematic steps. A good discussion needs only 5-6 paragraphs, which are structured along the following principles: (1) State the main findings (the punchline); (2) How does this work compare to prior studies, and how do they add to the literature?; (3) Limitations; (4) Implications; (5) Future directions. The final part is the Conclusions section. This is a statement that can only be supported by the results (be careful of causal inferences), but not a repeat of the Results. One can opt to end this part with an impact statement, especially around implications for research or clinical practice.

How an Editor Thinks

After our discussions with the registrants around constructing a manuscript, there was an open forum conversation trying to peek behind the curtain of the editorial process. Although it might seem to be a black box for many authors (and some reviewers), the goal was to highlight the work behind the scenes to determine the fitness of a manuscript for any particular journal and the layered work to assess the science and its presentation. Peer review is a pillar of academic life and, for most readers and authors, it is likely assumed that most journals employ confidential, external peer review as the central mechanism of research integrity and quality assurance. But the digital age has facilitated seemingly infinite venues to publish and the amount of science has grown exponentially. The ability of a handful of dedicated content experts in urology to act as a filter is impossible: there just are not enough reviewers to call upon.

Therefore prior to the formal peer review processes, a manuscript is first read and debated amongst a number of members of the editorial board. These discussions then lead to consensus whether the manuscript should be sent out for further external peer review by content experts to help determine if it’s a good fit for the mission of the journal. This is often a difficult task as the majority of manuscripts sent to our premiere journals in urology are of very high quality and represent sound science. If the manuscript is felt to be of high quality but, perhaps, has not risen to the bar of novelty for the flagship journal, it is often proposed to cascade to one of the sister journals that make up the family of publications at the AUA and EU. If the paper is determined to be of high priority by the editorial team, it is sent out for content review by leaders and rising stars in the field. Depending on the recommendations by these reviewers, an in-depth statistical review is sought, although this is often after a first round of revisions depending on the original feedback. Although these processes may seem arcane and time-consuming, they are fairly well orchestrated and the original first scan of the paper can be accomplished often in a few weeks’ time. Very few papers are accepted after a single pass by the reviewing team, often requiring several revisions specifically to ensure the highest quality of the statistical assessment and presentation. Many are returned as a major revision. Some of our best published works have been rejected with suggestions how to improve or focus the material and then asked to resubmit.

Our message to the audience was that these processes, although not perfect, generally do function well as a filter of sorts, allowing promising research to pass through and everting the promulgation of unsound findings. But after review by the editorial, reviewing, and statistical teams, the main goal of the journal is to help the authors create the highest quality publication from their data. After acceptance, it is our journal’s mission to promulgate it as effectively as possible so that it engages the widest possible audience to manifest the highest impact for the publication.

Future Directions

This was the first time a joint course between JU and EU was held since prior to the pandemic and a lot has changed in the medical publishing world. It is in all our best interest to work together as a scientific community to best advance urological care. The success of this course led to a further joint session at the AUA23 annual meeting in Chicago and future sessions are planned in Paris as well as San Antonio in 2024. Watch this space!