Level of scientific evidence underlying recommendations arising from the functional urology guidelines

Purpose: This study aimed to review the functional urology guidelines, relate the level of evidence (LOE) of their recommendations and highlight the discrepancies between the LOE and grade of recommendation. Materials and Methods: The electronic search was conducted in May 2019 and updated in February 2021. Three researchers separately reviewed the extracted guidelines based on the Appraisal of Guidelines for Research and Evaluation II instrument. We extracted recommendations from each guideline and ranked them into three Grades of A, B, and C; and their evidence into four levels of I to IV. Results: Among the published functional urology guidelines, 18 guidelines were published between 2014 and 2020. Overall, 592 recommendations were abstracted. Of these, 121 recommendations were related to evaluation or diagnosis, and the others (n = 471) on the disease management. These recommendations were in the field of urinary incontinence (UI) (n = 216), overactive bladder (OAB) (n = 172), lower urinary tract symptoms (LUTS) (n = 126), and neurogenic bladder (NGB) (n = 78). Subgroup analysis showed that most of the recommendations in relation to UI were Grade A (n = 111; 51.4%), and one-third were Grade C (n = 83; 38.4%). The remaining 22 recommendations were Grade B (10.2%). In OAB, most of the recommendations were Grade B (n = 67, 39.0%), 55 of them were Grade A (32.0%) and the rest were Grade C (n = 50, 29.1%). Among UI guidelines, 51 (45.9%) Grade A recommendations were supported by LOE I evidence, and 39 (47.0%) Grade C recommendations were supported by LOE IV evidence. Across OAB guidelines, 43 (78.2%) Grade A recommendations were supported by LOE I evidence, and 20 (40.0%) Grade C recommendations were supported by LOE IV evidence. Across LUTS guidelines, 34 (61.8%) Grade A recommendations were supported by LOE I evidence, and 14 (23.3%) Grade C recommendations were supported by LOE IV evidence. Among NGB guidelines, 21 Grade A recommendations were supported by LOE I evidence, and 9 Grade C recommendations were supported by LOE IV evidence. Conclusion: Most of the recommendations in the field of functional urology are not based on the systematic review and meta-analysis of randomized controlled trials (RCTs) and high quality RCTs; which indicates that more attention is still needed in making decisions based on the certainty and grade of recommendations

Comparison of luteal phase stimulation with follicular phase stimulation in poor ovarian response: a single-blinded randomized controlled trial

Abstract Background In the last decade, luteal-phase ovarian stimulation (LPOS) has been suggested as an alternative controlled ovarian stimulation (COS) protocol for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles mainly in women with a history of poor ovarian response (POR). The present randomized controlled trial study aimed to compare the outcomes of follicular phase ovarian stimulation (FPOS) and LPOS protocols in POR cases undergoing ICSI cycles. Methods Seventy-eight POR patients who met the Bologna criteria and underwent an ICSI cycle were included. In this study, 39 POR cases were allocated to the FPOS group, and 39 POR cases were allocated to the LPOS group. The primary outcome was the number of metaphase II (MII) oocytes. In addition, the total number of oocytes, number of top-quality day 3 embryo, day 3 embryo development rate, chemical pregnancy and clinical pregnancy rates were defined as secondary outcomes. Results The obtained results demonstrated that the number of MII oocytes significantly increased in the LPOS group compared to the FPOS group (P = 0.007). However, there was no significant difference between the two groups regarding the number of GV and MI oocytes, number of top-quality day 3 embryos and day 3 embryo development rate among both categories of patients. Also, the number of total and MII oocytes was significantly higher in the LPOS group (P = 0.016). Conclusion These results suggest that LPOS protocol effectively increases the number of mature oocytes in women with a history of POR. Trial registration IRCT20210405050852N1 (Registered at Iranian registry of clinical trials; available at https://en.irct.ir/trial/55402 )