EURURO Vol. 72 No. 5

788 860

utilising either ultrasound or electrohydraulic energy,
neither of which are recommended in contemporary
guidelines These simple differences underline the
problems with study heterogeneity and the impact of their
outcomes on systematic reviews.
In terms of surgical outcomes, prospectively collected
multicentre databases such as the Clinical Research Office of
the Endourology Society database and those managed by
national specialty associations can provide useful data on
trends in both treatment outcomes and techniques , but
the cases entered are inherently biased, and data are rarely
collected on the reasons for the particular treatment being
chosen. Surgeon-reported outcome data are also often
criticised for being less robust than adequate RCT data.
Possibly more importantly, we are finally beginning to
see a shift in the quality of data not only in terms of trial size
and design but also in the inclusion of validated patient-
reported outcomes (PROMs) and quality-of-life data, which
are sure to play a larger part in better informing our patients
to allow them to make the best decisions regarding their
management. Questionnaires such as the International
Stent Symptom Questionnaire are accepted and validated in
numerous languages for worldwide use and, alongside the
newer PROMs. It is to be hoped that these will not only allow
us to better understand the impact of treatments on
patients at an individual level but will also allow much
better homogeneity of trial outcome data and more
cohesive reviews and meta-analysis of data in the future.
Studies such as the SUSPEND trial have shown the value
of good-quality trial design and that it is feasible in modern
endourology practice to recruit large numbers of patients to
multicentre trials, thus improving our knowledge base.
Following on from the success of the SUSPEND trial in the
UK, the same research group has completed recruitment to
a further multicentre prospective RCT comparing SWL to
URS for the management of single ureteric calculi. The TISU
trial has recently closed to recruitment and should report in
the near future, and may go some way to furthering the
evidence base for this topic.
Management of upper ureteric calculi represents a daily
treatment challenge for endourologists. This most up-to-
date analysis of the data is a powerful reminder of the need
for a cohesive global approach to construction and reporting
of future trials in this area so that we can produce better-
quality guidelines for surgeons and ultimately clear
messages for our patients.
Conflicts of interest: Jacob Patterson has received payment from Porgès
Coloplast for consultancy, the post of advisory board chair, delivery of
educational courses, and sponsorship for meetings; from Boston
Scientific for consultancy and delivery of educational courses;
and from Astellas as sponsorship for meetings. William Finch has
received payment from Boston Scientifi c and Porgès Coloplast for
delivery of educational courses and from Boston Scientifi c for
consultancy.
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