Objective: The study aimed to explore adherence to the European Urological Association (EAU) Guidelines (GLs) grade A recommendation among Italian urologists. Materials and Methods: A 13-item multiple-choice questionnaire covering oncological and non-oncological urological diseases was e-mailed to all Italian Urologist Society (Società Italiana di Urologia or SIU) members. We asked members to provide an explanation for their answer choice where needed. The quantitative data were tested using the Pearson’s chi-square test. For all statistical comparisons, significance was considered as p < 0.05. Results: Of the 2011 invited SIU members, 210 (10.4%) completed the survey. The sample was composed of 22 (10.5%) Academic Urologists (AcUs), 110 (52.4%) Attending Urologists (AtUs), 32 (15.2%) Private Practice Urologists (PPUs), and 41 (19.5%) Residents in Urology (RUs). The mean adherence to the EAU Oncologic GLs ranged from 54.5 to 97.1%, while the adherence to the non-oncologic GLs ranged from 45 to 87.6%. We found that adherence differed across the working categories assessed. Conclusion: Our survey showed that professional role, updates, and local facilities seem to be the drivers that influence the non-adherence to the GLs. Urologists who work in university hospital would be more inclined to adopt the GLs compared to those who practice in non-academic centers.

1.
Greenfield S: Committee on standards for developing trustworthy clinical practice guidelines, 2011.
2.
Woolf SH, et al: Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318: 527–530.
3.
McGlynn EA, et al: The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348: 2635–2645.
4.
Cai T, et al: Adherence to european association of urology guidelines on prophylactic antibiotics: an important step in antimicrobial stewardship. Eur Urol 2016; 69: 276–283.
5.
Cookson MS, et al: National practice patterns for immediate postoperative instillation of chemotherapy in nonmuscle invasive bladder cancer. J Urol 2012; 187: 1571–1576.
6.
Heins MJ, et al: Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics. Eur J Public Health 2017; 27: 616–620.
7.
Morgia G, et al: Patterns of prescription and adherence to European association of urology guidelines on androgen deprivation therapy in prostate cancer: an Italian multicentre cross-sectional analysis from the choosing treatment for prostate cancer (CHOICE) study. BJU Int 2016; 117: 867–873.
8.
Association EU: European Urological Association Extended Guidelines, 2016.
9.
Phillips B, et al: Oxford Centre for Evidence-Based Medicine Levels of Evidence. Updated by Jeremy Howick, March 2009.
10.
American Association for Public Opinion Research: Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys, 2011.
11.
Bostick RM, et al: Using physician caller follow-ups to improve the response rate to a physician telephone survey. Eval Health Prof 1992; 15: 420–433.
12.
Cockburn J, et al: Response bias in a study of general practice. Fam Pract 1988; 5: 18–23.
13.
Kendrick T, et al: Distribution of mental health professionals working on site in English and Welsh general practices. BMJ 1993; 307: 544–546.
14.
Templeton L, et al: Surveying general practitioners: does a low response rate matter? Br J Gen Pract 1997; 47: 91–94.
15.
Sylvester RJ, et al: Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection with transurethral resection alone in patients with stage pTa-pT1 urothelial carcinoma of the bladder: which patients benefit from the instillation? Eur Urol 2016; 69: 231–244.
16.
Sylvester RJ, Oosterlinck W, van der Meijden AP: A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol 2004; 171(6 pt 1):2186–2190; quiz 2435.
17.
Bouffioux C, et al: Intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: results of 2 European organization for research and treatment of cancer randomized trials with mitomycin C and doxorubicin comparing early versus delayed instillations and short-term versus long-term treatment. European organization for research and treatment of cancer genitourinary group. J Urol 1995; 153(3 pt 2):934–941.
18.
Kaasinen E, et al: Factors explaining recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma. Eur Urol 2002; 42: 167–174.
19.
Sylvester RJ, Oosterlinck W, Witjes JA: The schedule and duration of intravesical chemotherapy in patients with non-muscle-invasive bladder cancer: a systematic review of the published results of randomized clinical trials. Eur Urol 2008; 53: 709–719.
20.
Witjes JA, Compérat E, Cowan NC, Gakis G, Lebrét T, van der Heijden AG, Ribal MJ, EAU Guidelines – Muscle Invasive and Metastatic Bladder Cancer, 2016.
21.
Keegan KA, et al: Increasing utilization of neoadjuvant chemotherapy for muscle-invasive bladder cancer in the United States. Curr Urol Rep 2014; 15: 394.
22.
Advanced Bladder Cancer (ABC) Meta-analysis Collaboration: Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 2005; 48: 202–205; discussion 205–206.
23.
Cowan NG, Chen Y, Downs TM, Bochner BH, Apolo AB, Porter MP, La Rochelle JC, Amling CL, Koppie TM: Neoadjuvant chemotherapy use in bladder cancer: a survey of current practice and opinions. Adv Urol 2014; 2014: 746298.
24.
Grossman HB, et al: Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003; 349: 859–866.
25.
Wollin DA, Makarov DV: Guideline of guidelines: imaging of localized prostate cancer. BJU Int 2015; 116: 526–530.
26.
Choi WW, et al: Overuse of imaging for staging low risk prostate cancer. J Urol 2011; 185: 1645–1649.
27.
Mottet N, Bellmunt J, Briers E, Bolla M, Cornford P, De Santis M, Henry A, Joniau S, Lam T, Mason MD, Matveev V, van der Poel H, van der Kwast TH, Rouvière O, Wiegel T. Guidelines Associates: van den Bergh RCN, van Casteren NJ, Everaerts W, Marconi L, Moldovan P: EAU Guidelines – Postate Cancer. European Association of Urology, 2016.
28.
Cooperberg MR, et al: Contemporary trends in low risk prostate cancer: risk assessment and treatment. J Urol 2007; 178(3 pt 2):S14–S19.
29.
National Comprehensive Cancer Network. Prostate Cancer (Version 1, 2015). http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf (accessed December 2014).
30.
National Institute for Health and Care Excellence. Prostate Cancer: Diagnosis and Treatment. 2014. https://www.nice.org.uk/guidance/cg175/resources/guidance-prostate-cancer-diagnosis-and-treatment-pdf.
32.
Artibani W, Cerruto MA: The role of imaging in urinary incontinence. BJU Int 2005; 95: 699–703.
33.
Artibani W, Andersen JT, Gajewski JB, et al: Imaging and other investigations; in Abrams PA, Cardozo L, Khoury S, Wein A (eds): Incontinence. 2nd International Consultation on Incontinence, July 13, 2001, pp 425–477.
34.
Bergman A, et al: Transrectal ultrasound versus cystography in the evaluation of anatomical stress urinary incontinence. Br J Urol 1988; 62: 228–234.
35.
Gufler H, et al: Comparison of cystourethrography and dynamic MRI in bladder neck descent. J Comput Assist Tomogr 2000; 24: 382–388.
36.
Francke AL, et al: Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Med Inform Decis Mak 2008; 8: 38.
37.
Wennberg JE: Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ 2002; 325: 961–964.
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