The present study aimed to identify discrepancies and areas of consensus between guidelines to give novel insights into areas where low consensus between the guideline panels exists in Urolithiasis surgical management and therefore where more evidence might increase consensus

A range of procedures is in use for the surgical treatment of urolithiasis. Treatment strategies are mainly based on stone location and size, and the patient’s comorbidities and preferences. Guidelines have been developed to support clinicians in selecting the most appropriate treatment in controversial situations. Several institutions around the world have issued guidelines incorporating the latest evidence.

However, even the most commonly cited guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA) leave the clinician with several treatment options and differ on specific points, such as cut-off values for stone size and recommendations for the treatment of choice.

Ambiguities and discrepancies between different guidelines may result from different interpretations of the evidence available and possible methodological differences in guideline creation. Therefore, careful analysis of the similarities and differences between different sources can provide additional insight.

Several societies around the world issue guidelines incorporating the latest evidence. However, even the most commonly cited guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA) leave the clinician with several treatment options and differ on specific points.

The webpages of the 61 members of the Societé Internationale d’Urologie were analysed to identify all listed or linked guidelines. Decision trees for the surgical management of urolithiasis were derived, and a comparative analysis was performed to determine consensus and discrepancies.

Five national and one international guideline (EAU) on surgical stone treatment were available for analysis. While seven national urological societies refer to the AUA guidelines and 11 to the EAU guidelines, 43 neither publish their guidelines nor relate to others.

Comparative analysis revealed a high degree of consensus for most renal and ureteral stone scenarios. Nevertheless, we also identified a variety of discrepancies between the different guidelines, the largest being the approach to the treatment of proximal ureteral calculi and larger renal calculi.

Six guidelines with recommendations for the surgical treatment of urolithiasis to support urologists in decision-making were available for inclusion in our analysis.

While there is a high grade of consensus for most stone scenarios, we also detected some discrepancies between different guidelines. These are, however, controversial situations where adequate evidence to assist with decision-making has yet to be elicited by further research.