[Strong recommendation] The pathological evaluation must include pTNM stage and tumour grade. [EXPERT OPINION] This is based on guideline consensus.
[Strong recommendation] p16 assessment by immunohistochemistry must be included. [EXPERT OPINION] Based on guideline consensus.
[Strong recommendation] Follow the ICCR dataset synoptic report. [EXPERT OPINION] Based on guideline consensus for standardization.
[Strong recommendation] Perform a detailed physical examination to record lesion characteristics. [MODERATE evidence] Based on observational studies showing reliability.
[Weak recommendation] Use MRI when there is uncertainty about corporal invasion or organ-sparing surgery; offer US if MRI is unavailable. [LOW evidence] Based on observational studies.
[Strong recommendation] Obtain a pre-treatment biopsy when malignancy is not obvious or non-surgical treatment is planned. [MODERATE evidence] Based on observational studies and clinical practice.
[Strong recommendation] Perform physical examination of both groins and record node characteristics. [EXPERT OPINION] Based on guideline consensus.
[Strong recommendation] Offer surgical lymph node staging to cN0 patients at high risk (T1b or higher). [MODERATE evidence] Based on observational studies showing improved survival with micro-metastatic removal.
[Weak recommendation] Discuss surveillance as an alternative to surgical staging for T1a G2 disease in compliant patients. [EXPERT OPINION] Based on guideline consensus and risk assessment.
[Strong recommendation] Offer DSNB when surgical staging is indicated; if unavailable, offer ILND. [MODERATE evidence] Based on studies showing DSNB's diagnostic accuracy and low morbidity.
[Strong recommendation] Perform inguinal ultrasound with FNAC of abnormal nodes before DSNB. [MODERATE evidence] Based on studies showing it reduces DSNB need and facilitates early treatment.
[Strong recommendation] Obtain a biopsy to confirm nodal metastasis in cN+ patients before treatment. [EXPERT OPINION] Based on guideline consensus for accurate staging.
[Strong recommendation] Use 18FDG-PET/CT or CT to stage the pelvis and exclude distant metastases in cN+ patients. [MODERATE evidence] Based on studies showing PET/CT's superior sensitivity and specificity.
[Strong recommendation] Use the TNM classification for staging prostate cancer. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Clinical stage should be based on digital rectal examination only, with imaging findings reported separately. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Use the ISUP 2019 system for grading prostate cancer. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Do not subject men to PSA testing without counselling on risks and benefits. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Offer early PSA testing to well-informed men at elevated risk, including those aged 50+, those with family history from 45+, African descent from 45+, and BRCA2 mutations from 40+. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Perform MRI before prostate biopsy in men with suspected organ-confined disease. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Offer active surveillance as the standard of care for low-risk prostate cancer. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Offer ADT combined with abiraterone plus prednisone, apalutamide, or enzalutamide to fit patients with M1 disease. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Offer 177Lu-PSMA-617 to pre-treated mCRPC patients with PSMA-expressing metastases on PET/CT scan. [Expert opinion] Based on guideline consensus.
[Strong recommendation] Offer twelve weeks of supervised combined aerobic and resistance exercise to men on ADT. [Expert opinion] Based on guideline consensus.
[Strong recommendation] All involved in managing chronic pelvic pain should have knowledge of peripheral and central pain mechanisms. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] Early assessment should involve investigations aimed at excluding disease-associated pelvic pain. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] Assess and address functional, emotional, behavioural, sexual, and quality of life issues early in patients with chronic pelvic pain. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] Build relations with colleagues to manage CPPPS comprehensively in a multi-disciplinary environment. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] Take a full history and evaluate to rule out treatable causes in all patients with chronic pelvic pain. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] Record margins with special attention to radial margin, prostate, ureter, urethra, peritoneal fat, uterus, and vaginal vault. [Expert Opinion] This is based on expert consensus to ensure complete resection assessment.
[Strong recommendation] Yes, offer neoadjuvant cisplatin-based combination chemotherapy to patients with T2-T4a, cN0 M0 disease who are eligible. [High evidence] This is based on multiple randomized trials demonstrating improved overall survival.
[Strong recommendation] Use enfortumab vedotin in combination with pembrolizumab as first-line treatment. [High evidence] This is supported by randomized clinical trials demonstrating significant overall survival benefits.
[Weak recommendation] Adjuvant nivolumab may be considered for selected patients with pT3/4 or pN+ disease who are not eligible for cisplatin-based chemotherapy. [Moderate evidence] This is based on trials like CheckMate 274, but evidence is not consistent across all studies.
[Strong recommendation] An extensive general history should be taken, concentrating on past and present symptoms. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] A specific history should be taken for urinary, bowel, sexual, and neurological functions. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Special attention should be paid to alarm symptoms like pain or fever, which require further investigation. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Quality of life should be assessed during evaluation and treatment. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Validated tools should be used for urinary and bowel symptoms. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] MSISQ-15 or MSISQ-19 should be used to evaluate sexual function. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Individual patient disabilities should be acknowledged when planning investigations. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Neurological status should be described completely, with all urogenital sensations and reflexes tested. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Anal sphincter and pelvic floor functions should be tested. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Urinalysis, blood chemistry, bladder diary, post-void residual, incontinence quantification, and urinary tract imaging should be performed. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] A urodynamic investigation should be performed to detect lower urinary tract dysfunction, with same-session repeat measurements. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Non-invasive testing must be performed before planning invasive urodynamics. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Video-urodynamics should be used; if unavailable, perform filling cystometry with pressure flow study. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] A physiological filling rate and body-warm saline should be used. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Blood pressure and heartrate should be monitored during urodynamic and other invasive procedures. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Antimuscarinic therapy should be used as the first-line medical treatment. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Mirabegron should not be used for reducing neurogenic detrusor overactivity. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] α-blockers should be prescribed to decrease bladder outlet resistance. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Parasympathomimetics should not be prescribed for underactive detrusor. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Intermittent catheterisation should be used as a standard treatment. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Patients should be thoroughly instructed in the technique and risks of intermittent catheterisation. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Indwelling transurethral and suprapubic catheterisation should be avoided whenever possible. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Intravesical oxybutynin should be offered to patients with poor tolerance to oral route. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Botulinum toxin injection should be used in the detrusor for multiple sclerosis or spinal cord injury patients. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Bladder augmentation should be offered. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] An autologous urethral sling should be placed as first-line treatment. [Expert opinion] Based on EAU guideline consensus.
[Weak recommendation] A synthetic urethral sling may be considered as an alternative in selected patients. [Expert opinion] Based on EAU guideline consensus.
[Weak recommendation] An artificial urinary sphincter may be inserted in selected patients, with referral to experienced centres. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] An artificial urinary sphincter should be inserted. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Sacral neuromodulation should be considered in selected patients. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Dipstick urine analysis should not be used for UTI screening. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Asymptomatic bacteriuria should not be screened for or treated. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Long-term antibiotics should be avoided for recurrent UTIs. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Optimise neuro-urological symptom treatment and remove foreign bodies from the urinary tract. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] UTI prophylaxis should be individualised due to lack of optimal measures. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Oral phosphodiesterase type 5 inhibitors should be prescribed as first-line treatment. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Intracavernous injections of vasoactive drugs should be given as second-line treatment. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Mechanical devices like vacuum devices and rings should be offered. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Vibrostimulation and transrectal electroejaculation should be performed for sperm retrieval. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Microsurgical epididymal sperm aspiration, testicular sperm extraction, and intracytoplasmic sperm injection should be performed. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Men with spinal cord injury at or above Th 6 and fertility clinics should be counseled about autonomic dysreflexia. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Medical therapy should not be offered for neurogenic sexual dysfunction in women. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] A multidisciplinary approach should be taken, tailored to individual needs and preferences. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] The upper urinary tract should be assessed at regular intervals. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] A physical examination and urine laboratory should be performed every year. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Significant clinical changes should prompt further specialised investigation. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Urodynamic investigation should be performed as a mandatory baseline at regular intervals. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Use the 2017 TNM classification system for staging bladder cancer. [Expert Opinion] This is based on guideline consensus.
[Weak recommendation] Provide T1 sub-stage if the lamina propria is adequately sampled, using micrometric or histo-anatomic principles. [Expert Opinion] This is based on guideline consensus.
[Weak recommendation] Use both the 1973 and 2004/2022 WHO grading systems, or a hybrid system. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] Do not use the term 'superficial bladder cancer'. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] Take a patient history focusing on urinary tract symptoms and haematuria. [Expert Opinion] This is based on guideline consensus.
[Strong recommendation] A complete medical history including symptoms and comorbidities, along with a focused physical examination, should be performed. [Expert Opinion] This is based on universal clinical consensus despite the absence of high-level evidence.
[Strong recommendation] A validated symptom score questionnaire that includes bother and quality of life assessment should be used during initial evaluation and for re-evaluation. [Low evidence] Based on observational studies (LE 3) showing utility in screening and categorisation.
[Strong recommendation] Patients should be asked to complete a bladder diary as part of standardised initial assessment and follow-up. [Expert Opinion] Based on clinical consensus for symptom quantification and monitoring.
[Strong recommendation] A complete medical history should be taken from men with LUTS. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Strong recommendation] Watchful waiting should be offered to men with mild/moderate, minimally bothered symptoms. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Strong recommendation] TURP (bipolar or monopolar) should be offered to surgically treat moderate-to-severe LUTS in men with prostate size 30-80 mL. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Weak recommendation] Underlying causes of nocturia should be treated, including behavioural, systemic conditions, sleep disorders, or LUT dysfunction. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Weak recommendation] Lifestyle advice should be offered to men with UI, but patients should be informed that evidence is lacking. [LOW evidence] Based on limited or observational studies.
[Strong recommendation] Antimuscarinic drugs or mirabegron should be offered to adults with urgency UI who failed conservative treatment. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Weak recommendation] Bulking agents should not be offered to men with post-prostatectomy incontinence. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Weak recommendation] Clean intermittent self-catheterisation should be initiated if there is risk of upper tract damage or PVR > 300 mL. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Weak recommendation] All patients who receive conservative, medical, or surgical management should be followed up. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[Strong recommendation] Topical corticosteroids (ointment or cream) are recommended as first-line treatment for symptomatic phimosis. [Expert opinion] Based on EAU guideline consensus.
[Weak recommendation] It is recommended to await spontaneous resolution of asymptomatic preputial adhesions before puberty. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Surgical orchidofunicolysis and orchidopexy should be performed before the age of twelve months, and by eighteen months at the latest. [Expert opinion] Based on EAU guideline consensus.
[Weak recommendation] Prenatal intervention is not recommended due to weak evidence and should be reserved for specialised centres in studies. [Very low evidence] Based on explicit statement of weak evidence.
[Strong recommendation] Use the 2017 TNM classification and 2022 WHO grading system for pathological staging and grading. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Use urethrocystoscopy with biopsy and urinary cytology to diagnose urethral carcinoma. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Assess the presence of distant metastases by computed tomography of the thorax and abdomen/pelvis. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Use pelvic magnetic resonance imaging to assess the local extent of urethral tumour and regional lymph node enlargement. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Offer distal urethrectomy as an alternative to penile amputation in localized distal urethral tumours, if negative surgical margins can be achieved intra-operatively. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Ensure complete circumferential assessment of the proximal urethral margin if penile-preserving surgery is intended. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Offer urethra-sparing surgery as an alternative to primary urethrectomy in females with distal urethral tumours, if negative surgical margins can be achieved intra-operatively. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Offer local radiotherapy as an alternative to urethral surgery in females with localized urethral tumours, but discuss local toxicity. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Refer patients with advanced urethral carcinoma to academic centres. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Discuss treatment of patients with locally-advanced urethral carcinoma within a multidisciplinary team of urologists, radiation-oncologists, and oncologists. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] In locally-advanced urethral carcinoma, use cisplatin-based chemotherapeutic regimens with curative intent prior to surgery. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] In locally-advanced squamous cell carcinoma of the urethra, offer the combination of curative radiotherapy with radiosensitising chemotherapy for definitive treatment and genital preservation. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Offer salvage surgery or radiotherapy to patients with urethral recurrence after primary treatment. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Offer inguinal lymph node dissection to patients with limited LN-positive urethral SCC. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Offer a urethra-sparing approach with transurethral resection and BCG to patients with non-invasive urethral carcinoma or carcinoma in situ of the prostatic urethra and prostatic ducts. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] In patients not responding to BCG, or with extensive ductal or stromal involvement, perform a cystoprostatectomy with extended pelvic lymphadenectomy. [Expert opinion evidence] Based on consensus guidelines.
[Conditional recommendation] Regional lymphadenectomy should be considered in clinically enlarged lymph nodes. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Consider neoadjuvant chemotherapy. [Expert opinion evidence] Based on consensus guidelines.
[Conditional recommendation] In extensive or BCG-unresponsive disease, consider (primary) cystoprostatectomy with or without urethrectomy and lymphadenectomy. [Expert opinion evidence] Based on consensus guidelines.
[STRONG recommendation] Increase physical activity, eliminate cigarette smoking, and in obese patients, reduce weight to decrease the risk of RCC. [LOW evidence] Based on observational studies linking lifestyle factors to RCC risk.
[STRONG recommendation] Use multi-phasic contrast-enhanced computed tomography (CT) of the abdomen and chest for the diagnosis and staging of renal tumours. [MODERATE evidence] Based on guideline consensus and supporting studies.
[STRONG recommendation] Offer partial nephrectomy (PN) to patients with T1 tumours. [HIGH evidence] Based on multiple randomized controlled trials and observational studies demonstrating better renal function and oncological outcomes compared to radical nephrectomy.
[STRONG recommendation] Do not perform cytoreductive nephrectomy (CN) in IMDC/MSKCC poor-risk patients. [MODERATE evidence] Based on randomized controlled trials demonstrating no overall survival benefit in this subgroup.
[STRONG recommendation] Offer nivolumab plus ipilimumab, pembrolizumab plus axitinib, lenvatinib plus pembrolizumab, or nivolumab plus cabozantinib to patients with IMDC intermediate- or poor-risk disease. [HIGH evidence] Based on multiple randomized controlled phase III trials demonstrating significant improvements in overall survival and progression-free survival compared to sunitinib.
[Strong recommendation] Offer pure or hand-assisted laparoscopic/retroperitoneoscopic surgery as the preferential technique for living-donor nephrectomy. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Perform open living-donor nephrectomy in centres where endoscopic techniques are not implemented. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Perform laparo-endoscopic single site surgery, robotic and natural orifice transluminal endoscopic surgery-assisted living-donor nephrectomy in highly-specialised centres only. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Use either University of Wisconsin or histidine tryptophane ketoglutarate preservation solutions for cold storage. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Use Celsior or Marshall’s solution for cold storage if University of Wisconsin or histidine tryptophane ketoglutarate solutions are not available. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Minimise ischaemia times. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Use hypothermic machine-perfusion (where available) in deceased donor kidneys to reduce delayed graft function. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Hypothermic machine-perfusion may be used in standard criteria deceased donor kidneys. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Use low pressure values in hypothermic machine perfusion preservation. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Hypothermic machine-perfusion must be continuous and controlled by pressure and not flow. [Expert opinion evidence] Based on EAU guideline consensus.
[Weak recommendation] Do not discard grafts due to only increased vascular resistance and high perfusate injury marker concentrations during hypothermic machine perfusion preservation. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Do not base decisions on the acceptance of a donor organ on histological findings alone; interpret histology in context with clinical parameters of donor and recipient, including perfusion parameters where available. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Use paraffin histology for histomorphology as it is superior to frozen sections; balance its diagnostic value against potential transplantation delay. [Expert opinion evidence] Based on EAU guideline consensus.
[Weak recommendation] Submit 14 or 16 G needle core biopsies, wedge biopsies or skin punch biopsies for histopathology. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Procurement biopsies should be read by a renal pathologist or a general pathologist with specific training in kidney pathology. [Expert opinion evidence] Based on EAU guideline consensus.
[Strong recommendation] Check for concomitant diseases, drugs, and substances that can interfere with testosterone production/action. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Measure total testosterone in the morning (7-11 AM) and in the fasting state using a reliable laboratory assay. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Repeat total testosterone measurement on at least two separate occasions when it is < 12 nmol/L and before starting testosterone therapy. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Use 12 nmol/L total testosterone (3.5 ng/mL) as a reliable threshold for diagnosing late-onset hypogonadism. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Measure sex hormone-binding globulin and calculate free testosterone when indicated in the diagnostic evaluation. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Analyse luteinising hormone and follicle-stimulating hormone serum levels to differentiate between primary and secondary hypogonadism. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Measure prolactin levels if low sexual desire or other suggestive symptoms are present and secondary hypogonadism is suspected. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Perform pituitary MRI in secondary hypogonadism with elevated prolactin or symptoms of a pituitary mass or other anterior pituitary hormone deficiency. [Expert opinion] Based on consensus guidelines.
[Weak recommendation] Perform pituitary MRI in secondary severe hypogonadism with total testosterone < 6 nmol/L, but the benefit-risk balance is unclear. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Screen for late-onset hypogonadism only in symptomatic men. [Expert opinion] Based on consensus guidelines.
[Strong recommendation] Evaluate patient and family history using modified Amsterdam II criteria to screen for Lynch syndrome. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Perform germline DNA sequencing in patients with clinical suspicion of hereditary UTUC. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Offer testing for MMR proteins or microsatellite instability in patients without clinical suspicion of hereditary UTUC. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Perform a urethrocystoscopy to rule out bladder tumour. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Perform voided urinary cytology in any case of suspicion of upper tract tumour. [Low evidence] Based on observational studies and diagnostic practices.
[Strong recommendation] Perform CT or MRI with urography for diagnosis and staging of all upper tract tumours. [Moderate evidence] Based on studies showing high diagnostic accuracy.
[Strong recommendation] Perform a chest CT in high-risk tumours. [Expert opinion evidence] Based on consensus guidelines for metastatic evaluation.
[Weak recommendation] 18F-FDG PET/CT may be used to rule out metastases in high-risk disease. [Low evidence] Based on limited observational data.
[Strong recommendation] Use diagnostic ureteroscopy if imaging and voided urine cytology are not sufficient for diagnosis or risk-stratification. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Test for FGFR 2/3 alterations at initial diagnosis in the metastatic setting. [Moderate evidence] Based on phase 3 trials showing benefit.
[Strong recommendation] Use prognostic factors to risk-stratify patients for therapeutic guidance. [Expert opinion evidence] Based on consensus guidelines.
[Strong recommendation] Offer kidney-sparing management as primary treatment option to patients with low-risk tumours. [Moderate evidence] Based on studies showing comparable oncological outcomes with reduced morbidity.
[Strong recommendation] Discuss both endoscopic management and distal ureterectomy in low-risk tumours of the distal ureter based on tumour characteristics and shared decision-making. [Expert opinion evidence] Based on consensus guidelines.
[Weak recommendation] Perform second look ureteroscopy within eight weeks following initial endoscopic management. [Low evidence] Based on observational data for recurrence monitoring.
[Strong recommendation] Discuss all patients with suspicion of UTUC on imaging in a multidisciplinary team meeting. [Expert opinion evidence] Based on consensus guidelines for comprehensive care.
[Strong recommendation] Perform radical nephroureterectomy (RNU) in patients with high-risk non-metastatic UTUC. [Moderate evidence] Based on studies establishing RNU as standard care.
[Weak recommendation] Use open, laparoscopic or robotic approach to perform RNU in patients with high-risk non-metastatic UTUC. [Moderate evidence] Based on studies showing equivalence in experienced settings.
[Weak recommendation] Perform a template-based lymphadenectomy in patients with high-risk non-metastatic UTUC. [Low evidence] Based on observational data with uncertain benefit.
[Strong recommendation] Offer adjuvant platinum-based chemotherapy after RNU to eligible patients with pT2–T4 and/or pN+ disease. [High evidence] Based on a phase 3 randomised trial showing improved disease-free survival.
[Strong recommendation] Deliver a post-operative bladder instillation of chemotherapy to lower the intravesical recurrence rate in patients without a history of bladder cancer. [Moderate evidence] Based on studies showing reduced recurrence risk.
[Weak recommendation] Discuss adjuvant nivolumab with PD-L1 patients unfit for or declining platinum-based adjuvant chemotherapy for specified high-risk disease. [Moderate evidence] Based on cohort studies with limited UTUC data.
[Weak recommendation] Discuss adjuvant pembrolizumab with patients unfit for or declining platinum-based adjuvant chemotherapy for specified high-risk disease. [Moderate evidence] Based on studies extrapolated from bladder cancer.
[Weak recommendation] Offer distal ureterectomy to selected patients with high-risk tumours limited to the distal ureter. [Low evidence] Based on case series and expert opinion.
[Strong recommendation] Discuss kidney-sparing management to high-risk patients with imperative indication on a case-by-case basis in shared decision-making. [Expert opinion evidence] Based on consensus guidelines for individualized care.
[Strong recommendation] Offer Enfortumab vedotin in combination with pembrolizumab as first-line treatment to patients with advanced/metastatic disease. [High evidence] Based on the EV302 phase 3 trial showing improved survival.
[Strong recommendation] Offer platinum combination chemotherapy to platinum-eligible patients. [High evidence] Based on long-standing standard of care and multiple clinical trials.
[Weak recommendation] Offer cisplatin based chemotherapy with gemcitabine-cisplatin + nivolumab in cisplatin eligible patients. [Moderate evidence] Based on extrapolation from bladder cancer studies.
[Strong recommendation] Offer cisplatin-based chemotherapy with gemcitabine/cisplatin or HD-MVAC to cisplatin-eligible patients. [High evidence] Based on established efficacy from clinical trials.
[Strong recommendation] Offer gemcitabine/carboplatin chemotherapy to cisplatin-ineligible patients. [High evidence] Based on clinical trials establishing efficacy in this population.
[Strong recommendation] Offer maintenance avelumab to patients who did not have disease progression after 4 to 6 cycles of platinum-based combination chemotherapy. [High evidence] Based on trials showing overall survival benefits.
[Weak recommendation] Offer checkpoint inhibitors pembrolizumab or atezolizumab to patients with PD-L1 positive tumours. [Moderate evidence] Based on studies in urothelial carcinoma with biomarker selection.
[Strong recommendation] Offer platinum based combination chemotherapy as second-line treatment of choice if not received in the first-line setting. [Moderate evidence] Based on clinical guidelines and practice.
[Strong recommendation] Offer checkpoint inhibitor (pembrolizumab) to patients with disease progression during or after platinum-based combination chemotherapy who did not receive maintenance avelumab. [High evidence] Based on trials establishing efficacy in this setting.
[Strong recommendation] Offer enfortumab vedotin to patients previously treated with platinum-containing chemotherapy and who progressed during or after PD-1/PD-L1 inhibitor therapy. [High evidence] Based on trials demonstrating benefit.
[Strong recommendation] Offer erdafitinib as an alternative subsequent-line therapy to patients pretreated with platinum and PD-1/PD-L1 inhibitors who harbour FGFR alterations. [High evidence] Based on the THOR phase 3 trial showing improved overall survival.
[Strong recommendation] Only offer vinflunine to patients with metastatic disease as second-line treatment if immunotherapy or combination chemotherapy is not feasible, or as third- or subsequent-line treatment. [Moderate evidence] Based on trials supporting its use in advanced settings.
[Weak recommendation] Offer nephroureterectomy as a palliative treatment to symptomatic patients with resectable locally advanced tumours. [Low evidence] Based on case series and expert opinion for symptom relief.
[Weak recommendation] After RNU for low-risk tumours, perform cystoscopy at 3 months, and if negative, at 9 months then yearly for 5 years. [Low evidence] Based on observational follow-up practices.
[Weak recommendation] In patients with previous history of NMIBC, perform cystoscopy and voided urinary cytology at 3 months, and if negative, every 3 months for 2 years, then every 6 months until 5 years, then yearly. [Low evidence] Based on standard follow-up protocols.
[Weak recommendation] In patients without previous history of NMIBC, perform cystoscopy and voided urinary cytology at 3 months, and if negative, every 6 months for 2 years, then yearly until 5 years. [Low evidence] Based on observational follow-up practices.
[Weak recommendation] Perform CT urography and chest CT every 6 months for 2 years, then yearly. [Low evidence] Based on follow-up protocols for detecting recurrences.
[Weak recommendation] After kidney-sparing management for low-risk tumours, perform cystoscopy at 3 and 6 months, then yearly for 5 years for bladder follow-up. [Low evidence] Based on observational follow-up data.
[Weak recommendation] For upper tract follow-up after negative second look URS, perform cross sectional imaging urography at 3 and 6 months then yearly for 5 years, with or without URS. [Low evidence] Based on follow-up practices with limited evidence on URS utility.
[Weak recommendation] In patients without previous history of NMIBC, follow-up the same as for high-risk tumours after RNU. [Low evidence] Based on extrapolated follow-up strategies.
[Weak recommendation] For upper tract follow-up after negative second look URS, perform cross sectional imaging urography and URS at 3 and 6 months, then imaging every 6 months for 2 years, then yearly for 5 years, with or without URS. [Low evidence] Based on follow-up protocols with limited evidence on URS utility.
[Strong recommendation] Advise safe sexual practices, recognize symptoms of sexually transmitted infection, and provide prompt investigation and treatment for men with urethritis. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Avoid unnecessary urethral catheterisation to prevent urethral strictures. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Weak recommendation] Do not use catheters larger than 18 Fr if urinary drainage only is the purpose, as the benefit-risk balance is unclear. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Use a validated patient-reported outcome measure (PROM) to assess symptom severity and impact on quality of life in men undergoing surgery for urethral stricture disease. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Do not use direct vision internal urethrotomy (DVIU) for penile strictures due to clear risks outweighing benefits. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Weak recommendation] Perform DVIU or dilatation for a primary, single, short (< 2 cm), non-obliterative stricture at the bulbar urethra, as the benefit-risk balance is unclear. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Offer augmentation urethroplasty by either a single-stage or staged approach to men with penile urethral stricture disease, considering previous interventions and stricture characteristics. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Perform flow rate, post-void residual, and voiding cystourethrogram or video-urodynamics in all women with refractory lower urinary tract symptoms to diagnose urethral strictures. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Use a graft above a flap when both are equally indicated for urethral reconstruction. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Offer follow-up to all patients after urethroplasty surgery to monitor outcomes. [Expert opinion evidence] Based on expert consensus from the EAU guidelines.
[Strong recommendation] Immediate imaging is indicated in patients with fever or solitary kidney, or when diagnosis is doubtful. [Expert Opinion] Based on EAU guideline consensus.
[Strong recommendation] Use non-contrast-enhanced computed tomography to confirm stone diagnosis in patients with acute flank pain following initial ultrasound assessment. [Expert Opinion] Based on EAU guideline consensus.
[Weak recommendation] Perform a dipstick test of spot urine sample for red cells, white cells, nitrites, approximate urine pH, and urine microscopy and/or culture. [Expert Opinion] Based on EAU guideline consensus.
[Strong recommendation] Offer a non-steroidal anti-inflammatory drug as the first choice for pain relief in acute renal colic, considering cardiovascular risk factors and side effects. [Expert Opinion] Based on EAU guideline consensus.
[Strong recommendation] Offer α-blockers as medical expulsive therapy for distal ureteral stones > 5 mm, noting it is an off-label use. [Low evidence] Based on contradictory evidence from studies.
[Strong recommendation] Perform percutaneous nephrolithotomy as first-line treatment for renal stones larger than 2 cm. [Expert Opinion] Based on EAU guideline consensus.
[Weak recommendation] Offer active surveillance to patients at high risk of thrombotic complications with asymptomatic calyceal stones. [Expert Opinion] Based on EAU guideline consensus.
[Strong recommendation] Do not screen or treat asymptomatic bacteriuria in conditions such as women without risk factors, patients with well-regulated diabetes, post-menopausal women, elderly institutionalised patients, those with dysfunctional lower urinary tracts, renal transplants, prior to arthroplasty surgeries, or recurrent UTIs. [Expert opinion] Based on EAU guideline consensus.
[Weak recommendation] Do not screen or treat asymptomatic bacteriuria in patients prior to cardiovascular surgeries. [Expert opinion] Based on EAU guideline consensus with uncertain benefit-risk balance.
[Strong recommendation] Screen for and treat asymptomatic bacteriuria prior to urological procedures that breach the mucosa. [Expert opinion] Based on EAU guideline consensus to reduce procedural infection risks.
[Weak recommendation] Screen for and treat asymptomatic bacteriuria in pregnant women using standard short-course treatment or single-dose fosfomycin trometamol. [Expert opinion] Based on EAU guideline consensus with uncertain evidence.
[Strong recommendation] Diagnose cystitis in women without other risk factors based on a focused history of lower urinary tract symptoms (dysuria, frequency, urgency) and absence of vaginal discharge or irritation. [Expert opinion] Based on EAU guideline consensus.
[Weak recommendation] Use urine dipstick testing for the diagnosis of acute cystitis. [Expert opinion] Based on EAU guideline consensus with uncertain evidence.
[Strong recommendation] Perform urine cultures in cases of suspected acute pyelonephritis, unresolved or recurrent symptoms within four weeks after treatment, women with atypical symptoms, or pregnant women. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Prescribe fosfomycin trometamol, pivmecillinam, or nitrofurantoin as first-line treatment for cystitis in women. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Do not use aminopenicillins or fluoroquinolones to treat cystitis. [Expert opinion] Based on EAU guideline consensus and regulatory safety concerns.
[Strong recommendation] Treat patients with pyelonephritis not requiring hospitalisation with short-course fluoroquinolones as first-line treatment. [Expert opinion] Based on EAU guideline consensus.
[Strong recommendation] Assess haemodynamic stability upon admission. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Record past renal surgery and known pre-existing renal abnormalities such as ureteropelvic junction obstruction, solitary kidney, or urolithiasis. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Test for haematuria in a patient with suspected renal injury. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Perform a multiphase CT scan in trauma patients with visible haematuria, non-visible haematuria and hypotension, rapid deceleration injury, significant associated injuries, penetrating trauma, or clinical signs of renal trauma. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Manage stable patients with blunt renal trauma non-operatively with close monitoring and re-imaging as required. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Manage isolated Grade 1-4 stab and low-velocity gunshot wounds in stable patients non-operatively. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Use selective angioembolisation for active renal bleeding if there are no other indications for immediate surgical exploration. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Insert urinary system drainage, such as ureteral stenting or nephrostomy, or perirenal drainage in cases of persistent or symptomatic urinary leak. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Proceed with renal exploration in the presence of persistent haemodynamic instability due to renal injury after failure of non-operative management. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Perform renal exploration in case of expanding or pulsatile peri-renal haematoma during laparotomy for associated injuries. [Expert opinion evidence] Based on guideline consensus.
[Weak recommendation] Attempt renal reconstruction if haemorrhage is controlled and there is sufficient viable renal parenchyma. [Expert opinion evidence] Based on guideline consensus.
[Strong recommendation] Repeat imaging in high-grade and penetrating injuries and in cases of fever, worsening flank pain, or falling haematocrit. [Expert opinion evidence] Based on guideline consensus.
[Weak recommendation] Follow-up approximately three months after major renal injury with urinalysis, individualised radiological investigation, blood pressure measurement, and renal function tests, with longer term annual blood pressure monitoring. [Expert opinion evidence] Based on guideline consensus.