"Spin" refers to language manipulation that either downplays potential harms of treatment or attempts to positively reflects negative/equivocal result. The use of spin when reporting clinical research, particularly randomised controlled trials (RCTS) is widespread and has been highlighted in other medical and surgical specialties. Even the most diligent of readers can be deceived by this manipulation of language, leading to incorrect understanding of RCT outcomes and as a result misguided confidence in subpar or ineffective treatments. The goal of this study was to characterize the extent of spin, and the types of strategies used, in statistically non-significant RCTs relevant to Urology.

We performed a cross-sectional study of RCTs studying urological disease published in the top 15 relevant journals by impact factor between 2022 and 2024. Studies with a non-significant primary or co-primary outcome were included. Strategies of spin were analysed in the results, discussion and conclusion section of each article using a previously described analysis tool

1638 articles were identified and screened. 61 articles met inclusion criteria and were analysed. Spin was identified in 32 articles (52.4%). No articles had spin in the title. Spin was identified in the results section of 26 articles (34.4%) and conclusion of 18 articles (29.5%). The most common strategy of spin was focusing on significant secondary outcomes. 10 articles claimed treatment efficacy in the conclusion despite non-significant primary end points.

A majority of Urology RCTs with a non-significant primary use some form of spin to manipulate the interpretation of their findings. Readers should be aware of commonly employed spin strategies and must be diligent to critically appraise articles themselves, particularly if planning on applying the results of RCTs to clinical practice. Writers should ensure they are avoiding common, or other spin, strategies to avoid misleading readers.