Guideline-based recommendations are widely regarded as a valuable resource for practicing urologists and residents in training, enabling evidence-based decision-making derived from rigorously conducted studies. These recommendations play a crucial role in aiding physicians during the complex decision-making process, helping them identify the most appropriate treatment options among available alternatives. The credibility of these guidelines stems from the rigorous and detailed evaluation of evidence-based data within the literature. Consequently, clinical guidelines are considered a reliable source of information, not only for healthcare providers but also for insurance companies, as they aim to enhance the quality of care delivered in clinical practice [19, 20].

This study aimed to evaluate local practice patterns regarding the use of urolithiasis guidelines in Turkey. To our knowledge, this is the first study to focus on critical factors influencing the clinical application of these guidelines by national urologists, particularly those involved in the management of urolithiasis.

Studies addressing the attitudes of urologists toward the local use of urolithiasis guidelines are extremely limited. The only comparable study, conducted by Fadrique GG et al., assessed adherence to clinical guidelines for urinary stone management. However, that study involved only 12 urologists from 8 hospitals, evaluating their decisions in 723 cases. It revealed lower-than-expected adherence rates to guideline recommendations, with higher compliance observed for managing smaller renal and ureteral stones, while lower adherence was noted for planning treatments for larger stones [18].

Our study provides several key findings that highlight the current state of local practice patterns regarding urolithiasis guidelines in Turkey. Most notably, 82.5% of participating urologists were highly experienced in stone management, performing at least 20 procedures per month. Among all respondents, 84.7% reported benefiting from guideline recommendations to varying degrees, while a small but notable percentage (2.1%) did not use guidelines in their routine practice.

Access to and effective use of local (Turkish) versions of the guidelines varied according to the participants’ level of experience. While less experienced urologists and residents tended to rely more heavily on these versions, experienced practitioners used them less frequently. This disparity does not necessarily imply that experienced urologists disregard guidelines but rather reflects their accumulated clinical expertise and proficiency in utilizing other resources, including international guideline versions. Importantly, 41% of respondents emphasized the utility of having local guideline texts readily available for reference.

Half of the respondents reported receiving no formal training or education on the preparation, content, or use of guidelines during their careers. This highlights the need for targeted educational efforts, particularly for medical students and residents in training. Introducing guideline-based recommendations through university and training hospital programs, as part of presentations or clinical case discussions, could familiarize future practitioners with their importance and application. For instance, guidelines could be incorporated into annual educational activities, with residents presenting recommendations to their peers and supervisors.

Despite the high level of experience among the majority of participants (82.5%), the rate of regular use of guidelines was lower than expected. This finding suggests that experienced urologists may feel sufficiently knowledgeable to apply guideline principles without consulting the texts directly. While almost all respondents reported using European Association of Urology (EAU) guidelines, only about half utilized American Urological Association (AUA) guidelines, reflecting the geographical and professional context of the participants practicing in a European region.

The primary motivations for using guideline-based information in clinical practice were improving treatment standards (90.5%) and reducing complication risks. Additionally, 48.2% of respondents used guidelines to mitigate legal risks, while 43.3% sought to enhance their knowledge and skills. Interestingly, nearly half of the participants viewed guideline recommendations as beneficial for minimizing legal risks, a concern that is gaining increasing relevance in contemporary medical practice. This underscores the potential role of guideline recommendations in legal evaluations of complex cases with severe complications.

Another critical finding was the perception among many respondents that the personal opinions and beliefs of guideline committee members could influence the content and reliability of recommendations. Supporting this, 12.7% of participants expressed skepticism regarding the evidence-based foundation of guideline recommendations, suggesting that some guidelines may lack sufficient rigor in their preparation. These insights indicate a need for guideline committees to adopt new approaches that enhance transparency, reliability, and user confidence.

Our study is not without limitations. First, the survey included many questions, and the time-consuming nature of the questionnaire may have contributed to a lower response rate. Although a follow-up email was sent one month after the initial invitation, participation remained lower than anticipated. Additional reminder emails might have improved the response rate, but logistical constraints prevented this. Nonetheless, as the first study examining the local application of urolithiasis guidelines, we believe our findings provide valuable insights into the approaches of Turkish urologists to these recommendations.