EAU, AUA and NICE Guidelines on Surgical and Minimally Invasive Treatment of Benign Prostate Hyperplasia: A Critical Appraisal of the Guidelines Using the AGREE-II Tool

Abstract

<b><i>Objective:</i></b> To critically appraise the methodological rigour of the clinical practice guidelines (CPGs) vis-à-vis BPH surgery as used by specialist research associations in the US, Europe and UK, and to compare whether the guidelines cover all or only some of the available treatments. <b><i>Methods:</i></b> The current guidelines issued by the EUA, AUA and NICE associations have been analyzed by 4 appraisers using the AGREE-II instrument. We also compared the recommendations given in the guidelines for surgical and minimally invasive treatment to find out which of these CPGs include most of the available treatment options. <b><i>Results:</i></b> According to the AGREE II tool, the median scores of domains were: domain 1 scope and purpose 66.7%, domain 2 stakeholder involvement 50.0%, domain 3 rigor of development 65.1%, domain 4 clarity of presentation 80.6%, domain 5 applicability 33.3%, domain 6 editorial independence 72.9%. The overall assessment according to AGREE II is 83.3%. The NICE guideline scored highest on 5 out of 6 domains and the highest overall assessment score (91.6%). The EAU guideline scored lowest on 4 out of 6 domains and has the lowest overall assessment score (79.1%). <b><i>Conclusions:</i></b> The analyzed CPGs comprehensively highlight the minimally invasive and surgical treatment options for BPH. According to the AGREE II tool, the domains for clarity of presentation and editorial independence received the highest scores. The stakeholder involvement and applicability domains were ranked as the lowest. Improving the CPG in these domains may help to improve the clinical utility and applicability of CPGs.

Laser enucleation of the prostate in men with very large glands ≥175 ml: A systematic review

“…In light of the latest evidence, this paradigm is evolving toward minimally-invasive endoscopic solutions. EAU guidelines on the surgical treatment of large prostates recommend SP for large prostates (>80 ml) when endoscopic prostate enucleation is not available [ 12 ]. Except for prostate sizes of 80–100 ml, there are very few studies reporting 150, 175 and 200 ml as a cut off value to investigate the efficiency and safety of laser enucleation in prostates this large.…”

“…Surgical treatment options for BPH may differ according to the prostate's size [ 2 ]. Although there is evidence that EEP is feasible regardless of prostate size [ 10 , 11 ], the European Association of Urology (EAU) and American Urological Association (AUA) guidelines recommend laser-based EEP such as HoLEP for prostates with a size >80 ml [ 12 ]. In the literature, prostate sizes above 80–100 ml were defined as ‘large prostates’ and most studies on EEP are limited to these prostate sizes [ [13] , [14] , [15] , [16] , [17] ].…”

Critical Appraisal of the National Institute for Health and Care Excellence (NICE) Guidelines for Spine Disorders using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II)

“…All guidelines contained accessible documents to assist doctors putting 'guidance into practice'. However in many cases, assessors may have found these documents non guideline-speci c. Four previous NICE guidelines evaluated using AGREE II resulted in a wide range of scores in this domain, with some authors agreeing that applicability represented their weakest domain (scores of 48 and 56 [11][12] ), whereas others rated it highly (scores of 82 and 100 [9][10] ). The applicability of a guideline is key to its success but may be dependent on heterogenous structural factors within the National Health Service systems, and therefore requires independent consideration.…”

“…The AGREE II tool has been used independently to evaluate several NICE guidelines, involving urological and endocrine system disorders [9][10][11][12] , but there are currently no studies using the AGREE II tool to evaluate NICE guidelines for musculoskeletal or neurosurgical conditions. The purpose of this study is to use the AGREE II tool to assess quality of NICE guidelines for spine disorders.…”

Controversies in Prostate Artery Embolization: Future Best Practice

“…15 However, the UK NICE guidelines now support the use of PAE and the EAU guidelines lie in the middle. 16 Retrospective, prospective, and randomized safety and efficacy data to date clearly demonstrate the role of PAE in the treatment of LUTS secondary to BPH; any further debate about its role in guidelines is purely academic or political.…”