Methodological Quality of Systematic Reviews for Questions of Therapy and Prevention Published in the Urological Literature (2016–2021) Fails to Improve

Abstract

ObjectivesPrior 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).MethodsAs 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.ResultsOur 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.ConclusionsMost 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.