Du C, Harandi AA, Hwang K, Hill J, Adler HL. Analysis of the AUA guidelines: strength of evidence correlates with recommendation levels. Urol Pract. 2023;10.1097/UPJ.0000000000000373.

Study Need and Importance

In 1989, the AUA established the Practice Guidelines Committee to publish evidence-based guidelines on various urological conditions to aid clinical decision-making. In 2008, the AUA mandated that guideline recommendations include a new evidence-rating system to indicate the level of literature backing each statement. There is a paucity of studies investigating the caliber of evidence used to create AUA guidelines. This study investigates the evidence grade of available AUA guideline statements, their association with oncology or benign conditions, and their association with stage of care.

What We Found

After reviewing 939 statements across 29 urological conditions, we found that most guideline statements are not backed by Grade A evidence. Less than 25% of statements were Grade A or Grade B. Statements for oncologic topics were more likely to have Grade A or Grade B evidence. Similarly, guidelines pertaining to treatment of a condition were more likely to be backed by Grade A or Grade B evidence than diagnostic or follow-up statements (see Table). These low evidence-grade statements may play a role in the low adherence of physicians to societal guidelines within urology.

Limitations

This was an observational study of the AUA guideline statements and their associated grade of evidence. We did not assess the accuracy of the grading system or compare these guidelines to other specialty guidelines.

Interpretation for Patient Care

Though the AUA has established a robust system for systematic review of the literature and a panel of experts to compose guidelines, most statements are not backed by high-grade evidence. Further research is necessary to provide evidence basis for these statements and to improve physician compliance with guidelines.