Levels of Evidence and Clinical Guidelines-Considerations for the Practicing Urologist.

Introduction: It is important for urologists to remain up-to-date regarding research and clinical guidelines within their specialty. This has become increasingly difficult as the volume of research increases while the quality of evidence has not followed suit. It is, therefore, important for urologists to understand the methodology of critical appraisal of evidence, for both the assessment of individual journal articles as well as the construction of organizational clinical guidelines.

Methods: The methodology for clinical guideline creation used by the American Urological Association (AUA) is reviewed along with that of the U.S. Preventive Services Task Force (USPSTF). Two popular grading schemas are then reviewed to provide an overview of existing methods for the critical analysis of research. We conclude with a description of the Grading of Recommendations Assessment Development and Evaluation (GRADE)-a classification system that attempts to unify various grading systems and is rapidly gaining popularity among well-reputed national organizations.

Results: The AUA uses a systematic and evidence-based approach to creating clinical guidelines. The USPSTF is similar to the AUA in its approach to reviewing the literature and creating guidelines. The Centre for Evidence Based Medicine offers a novel approach to evidence-based literature review, providing a metric for the analysis of the literature to answer specific clinical questions. GRADE is working toward the development of a more transparent and standardized approach to the creation and reporting of clinical guidelines.

Conclusions: A number of organizations have attempted to standardize and clarify the literature review process to provide physicians with tools to critically evaluate higher quality evidence and apply guidelines to clinical practice. As urologists, we must understand how national organizations review the literature and develop clinical guidelines. Additionally, we must develop our own process for reviewing the literature in order to answer questions that have not yet been addressed by these organizations. Kirby EW, Borawski KM, and Smith AB. Levels of evidence and clinical guidelines-Considerations for the practicing urologist. Sex Med Rev 2013;1:17-23.