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Year : 2011  |  Volume : 27  |  Issue : 4  |  Page : 485-486

Another milestone toward a more evidence-based practice of urology

1 Division of Pediatric Urology, Nationwide Children's Hospital, Ohio State University Columbus, OH, USA
2 Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA

Date of Web Publication4-Jan-2012

Correspondence Address:
Philipp Dahm
Associate Professor of Urology, Department of Urology, College of Medicine, University of Florida, Health Science Center Box 100247, Room N-203, Gainesville, FL, 32610-0247
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-1591.91437

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How to cite this article:
Singh J C, Dahm P. Another milestone toward a more evidence-based practice of urology. Indian J Urol 2011;27:485-6

How to cite this URL:
Singh J C, Dahm P. Another milestone toward a more evidence-based practice of urology. Indian J Urol [serial online] 2011 [cited 2021 Jul 31];27:485-6. Available from:

Evidence-based medicine has been widely credited with having revolutionized the practice of medicine, and urology is no exception. Although the term was coined less than two decades ago, [1] the importance of integrating the best available evidence into clinical practice has been well accepted, emphasized and widely promoted. The term presents the ultimate turn from clinical decisions based on anecdote to the ideal of Baconian empiricism rendered in medical science. [2]

Publications in The Journal of Urology[3] and BJU International[4] in the past have introduced the concepts and principles of evidence-based medicine with relevant scenarios in urology, thus highlighting its importance to guide clinical practice. Most recently, the World Journal of Urology has published a symposium on the broad impact of evidence-based urology, with 11 articles providing in-depth analyses of the influence of evidence-based medicine on key areas of clinical practice, education, publishing, health policy and clinical research. [5]

Indian urologists have been well aware of the principles of evidence-based medicine for over a decade. Realizing the importance and potential impact of evidence-based urology, it was chosen as the topic for the Sitaraman Memorial Essay Competition in 2002 by the Urological Society of India, resulting in the publication of the selected essay in Indian Journal of Urology. [6] In addition, an exclusive section was dedicated for evidence-based urology in Indian Journal of Urology way back in 2005, [7] and the articles in this section were very popular and highly accessed since they dealt with some of the commonly encountered dilemmas.

It is heartening to note that an entire symposium has been dedicated to evidence-based urology in an issue that complements the existing body of literature and addresses a series of critical topics that have remained unaddressed so far. In this symposium, Mazel et al. describe the fundamentals of evidence-based medicine and provide concrete guidance on how to integrate the best available evidence with an individual patient's values and preferences to optimize patient care. They enumerate the various sources of evidence and debunk the many misconceptions about evidence-based medicine that continue to exist. Sur discusses the history and evolution of clinical epidemiology and evidence-based medicine and the subsequent formation of the Cochrane Collaboration. A study by Tseng et al. reviews the principles of statistical hypothesis testing in clinical research and emphasizes the importance of confidence intervals over P-values when interpreting the results. The importance of sample size and the appropriate interpretation of so called negative studies are subject to an article by Canfield et al. This is followed by several articles focusing on the critical appraisal of different types of study designs: Dorairajan et al. use the example of gross hematuria to illustrate how to appraise a diagnostic test. They highlight the three vital questions to be addressed critically - the validity of the test, results and applicability. Breau et al. discuss the critical appraisal of evidence pertaining to the prognosis of disease, using the example of an incidentally discovered renal mass. Scales et al. review the critical appraisal of a therapy article, using a prostate cancer prevention trial as an example. Systematic reviews summarize the entire body of evidence for a given clinical question and therefore provide the highest level of evidence. An approach to assessing their quality and interpretation is discussed by Scales et al. in their manuscript. An important principle such as evidence-based medicine can be further developed only if effective teaching strategies are developed. Using the example of targeted therapy in metastatic renal cell carcinoma, Dahm et al. review the critical appraisal of clinical practice guidelines and introduce the GRADE framework for rating the quality of evidence and strength of recommendations. Lastly, Hajebrahimi et al. introduce effective strategies on how to teach evidence-based medicine to both urology residents as well as busy clinicians. Hajebrahimi et al. also elaborate on designing a clinical trial and producing robust evidence for the future. Teaching the next generation of urologists a methodical approach to searching, appraising and applying the current best evidence will be critical to the advancement of safe, effective and affordable patient care for the patients we serve.

It has been a pleasure for both of us to closely work with these authors to bring this symposium together which is meant to serve as a valuable resource for all practicing urologists of varying levels of clinical experience. We hope that this series of articles will help identify areas of deficiencies in the urology evidence base, spurn further high quality research and inspire many individuals to become champions of evidence-based urology in their community.

   References Top

1.Oxman AD, Sackett DL, Guyatt GH. Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA 1993;270:2093-5.  Back to cited text no. 1
2.Niederberger C. Evidence-based medicine in urology: Hope and peril. J Urol 2009;181:1528.  Back to cited text no. 2
3.Scales CD Jr, Preminger GM, Keitz SA, Dahm P. Evidence based clinical practice: A primer for urologists. J Urol 2007;178:775-82.  Back to cited text no. 3
4.Dahm P, Preminger GM. Introducing levels of evidence to publications in urology. BJU Int 2007;100:246-7.  Back to cited text no. 4
5.Dahm P, Konety BR. Evidence-based medicine in urology. World J Urol 2011;29:255-6.  Back to cited text no. 5
6.Singh J. Evidence-based urology. Indian J Urol 2005;21:70.  Back to cited text no. 6
  Medknow Journal  
7.Kumar S. Ureteroscopic lithotripsy - skip the stent and spare the patient. Indian J Urol 2005;21:116.  Back to cited text no. 7
  Medknow Journal  


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