For the 2018 edition of the EAU Male LUTS Guidelines the Guidelines Office have transitioned to a modified GRADE methodology. For each recommendation within the guidelines there is an accompanying online strength rating form which addresses a number of key elements namely:

the overall quality of the evidence which exists for the recommendation;
the magnitude of the effect (individual or combined effects);
the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
the balance between desirable and undesirable outcomes;
the impact of patient values and preferences on the intervention;
the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence, and nature and variability of patient values and preferences. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’. All recommendations have been rephrased throughout the current document to aid in their implementation.

In addition, the following sections of the Male LUTS have been adapted or added to the text:

5.3.1.1.1 Modifications of B-TURP: bipolar transurethral vaporisation of the prostate
5.3.5 Laser treatments of the prostate
7 Topics under consideration for future evaluation by the Male LUTS Guidelines Panel