Methodological Quality of Systematic Reviews for Questions of Therapy and Prevention Published in the Urological Literature (2016–2021) Fails to Improve
Objectives Prior studies have suggested that few systematic reviews (SRs) published in the urological literature
provide reliable evidence. We performed this study to provide a longitudinal analysis of the methodological quality of
SRs published in 5 major urology journals over a 6-year period (2016–2021).
Methods As an extension of a prior study with a written a priori protocol, we systematically searched and analyzed
all SRs related to questions of therapy or prevention published in the 5 major urology journals. Three independent
reviewers working in pairs selected eligible studies and abstracted the data in duplicate. We used the updated
Assessment of Multiple Systematic Reviews (AMSTAR-2) instrument to assess SR quality. We performed pre-planned
statistical hypothesis testing by time period and journal of publication in SPSS Version 27.0.
Results Our updated search (2019–2021) identified 563 references of which 114 ultimately met inclusion criteria,
which we added to the database of the prior 144 studies (2016–2018). Overall, among 258 SRs, only 6 (2.3%) and 9 SRs
(3.5%), achieved a “high” (no critical weakness; up to one non-critical weakness) or “moderate” (no critical weakness;
more than one non-critical weakness) confidence rating, respectively. Most SRs published had very low confidence
rating (195; 75.6%). The proportion of studies with a high or moderate rating (6.1% versus 4.9%; P = 0.481) did not
increase over time.
Conclusions Most SRs published in the urological literature continue to have serious methodological limitations
and should not be relied upon. There is a critical need for greater awareness for established methodological standards.
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