Guideline of the Guidelines: Urolithiasis

Fahad Quhal; Christian Seitz


Curr Opin Urol. 2021;31(2):125-129. 

In This Article


Clinical practice guidelines serve to create a well tolerated and evidence-based practice and help advise physicians on providing the most appropriate treatments for their patients,[13,14] a goal that can only be achieved through strong evidence that is frequently updated. For the current review, we compared the key points of the international guidelines on urolithiasis, including those updated within the past five years.

We found that the EAU guidelines was the most updated. The EAU and the AUA/ES guidelines provide the most comprehensive review of evidence to provide recommendations on the various aspects of the disease. The EAU and the AUA/ES are the most commonly cited guidelines on the management of urolithiasis.[15] A recent study that utilized the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate the quality of different international guidelines on the surgical management of stones. The authors reported high quality for these two guidelines. They further noted the similarities in the most important recommendations regarding the surgical management.[16,17]

Although the guidelines are based on evidence-based literature review, it should be noted that different clinical societies can differ in their recommendations despite similar literature and evidence pool. These differences might be related to the inclusion criteria of evidence, and the different methods of grading. Scientific evidence is in constant change; therefore, clinical practice guidelines need to be updated regularly in order to maintain its validity.[18] However, there is no consensus on how frequent these guidelines should be updated. Furthermore, guidelines are based on evidence; and, if evidence is limited it does not necessarily imply that an intervention has no role, but rather a recommendation cannot be made based on the available evidence.