Urolithiasis is a significantly common disease globally, despite the notable difference in the rate of occurrence based on various factors like gender, climate, diet, and other risk factors. There has been a yearly increase in the prevalence of stone occurrence in people above the age of 30 for all genders [1]. This rise in incidence, along with advances in modern technology, places a significant financial burden on healthcare facilities for the treatment of kidney stone disease (KSD), accounting for an estimated USD 5.3 billion spent on the disease globally in 2014, making it the second most costly urological ailment [2].
Extensive guidelines on urolithiasis have been published by various accomplished institutes throughout the world. Those developed by the American Urology Association (AUA) and the European Association of Urology (EAU) are widely accepted and used by clinicians worldwide to help them in the diagnosis, management, and follow-up of patients with kidney stone disease (KSD). Separate guidelines are published by the AUA for the medical and surgical management of KSD, which last saw an update in 2019 and 2016, respectively [3,4]. In comparison, the EAU provides a single document titled Urolithiasis for the management of urinary tract stones, with the latest update being in 2023 [5].
Separate methods are used by both guidelines to assess the strength of evidence used in the guidelines. The AUA guidelines use letters for grading, namely A, B, and C, depending on the quality and certainty of the evidence [6]; this is followed by certain nomenclature that differs for medical and surgical guidelines. The surgical guidelines use statements of strong, moderate, or conditional recommendations, whereas the medical guidelines use nomenclature reflecting the options, recommendations, and standards, all of which are based on the risk–benefit ratio for patients. Cases where evidence is lacking, clinical principles, and expert opinions are used to provide additional information.
In contrast, the EAU classifies its recommendations as “strong” or “weak”, using the guiding concept of the GRADE methodology [7], based on various factors, such as the quality and extent of the effect, certainty, balanced outcomes, and patient values and preferences [8]. The EAU guidelines also outline goals that the panel aims to achieve for the 2024 update, which are aimed at further evaluating evidence for efficient practice in endourology and questioning the accuracy of the stone size in selecting treatment options.
While guidelines provide valuable information and clinical frameworks by consolidating the best available evidence, they can never guarantee the best results for patients, especially due to limitations in their upgradation [8]. Hence, when formulating a treatment plan, clinical expertise and individual patient circumstances should always be the foremost factors under consideration, and guidelines should never override these.