Background: High quality systematic reviews (SRs) have a paramount role in informing evidence-based clinical practice. Cochrane has pioneered and disseminated many of the methodological underpinnings across all areas of medicine including urology.
Objectives: To assess the quality of published systematic reviews in the urological literature outside the Cochrane Library.
Methods: As an extension of an earlier-published study (MacDonald 2010), we systematically searched PubMed and handsearched the table of contents of four major urological journals from January 2013 to December 2015 to identify SRs related to questions of prevention and therapy. Two independent reviewers assessed the methodological quality using the 11−point Assessment of Multiple Systematic Reviews (AMSTAR) instrument. We performed protocol-driven analyses for the 2013-15 time-period alone and in aggregate with earlier data for the 1998-2012 time-period.
Results: The updated literature search identified 490 studies of which 130 ultimately met inclusion criteria. The most common SR topic in 2013-15 was oncology (68; 52.3%) followed by voiding dysfunction (28; 21.5%) and stones/endourology (10; 7.7%). The mean AMSTAR scores ± SD for 2013-15 (n = 130), 2009-2012 (n = 113) and 1998-2008 (n = 57) were 4.9 ± 2.4, 5.4 ± 2.3 and 4.8 ± 2.5, respectively (P = 0.160). SRs scored highest for the description of the studies’ baseline characteristics (118; 90.8%) and comprehensive literature search of two or more databases (105; 80.8%). They scored lowest on conflict of interest COI) reporting (6; 4.6%), and the inclusion of unpublished studies to avoid publication bias (10; 7.7%).
Conclusions: There has been an exponential increase in the number of SRs published in the urological literature year by year, but a stagnation of methodological quality. One major distinction of non-Cochrane reviews is the lack of transparent COI reporting. SR authors should apply established methodological standards to enhance the validity and impact of SRs