Environmental sustainability in urologic practices: a systematic review

Abstract

Purpose: The aim of this systematic review is to assess the environmental impact of urologic procedures and equipment (P), specifically comparing emissions and waste generation between single-use and reusable devices (I and C), while also exploring strategies for emission reduction and providing relevant recommendations for sustainable practices in urology. Methods: The review registered to PROSPERO (ID: CRD42024576865) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted to identify studies addressing sustainability, carbon footprint, and environmental impact in urology. A total of 7714 records were initially identified, of which ten met the inclusion criteria. Study quality was assessed using the QUADAS scoring system to evaluate risk of bias and applicability concerns. Results: Ten studies met the inclusion criteria, focusing on the environmental impacts of urologic devices and procedures (O). Single-use cystoscopes demonstrated lower carbon dioxide (CO2) emissions per procedure (2.41 kg) compared to their reusable counterparts (4.23 kg) but produced more waste (622 g). Reusable cystoscopes, while having a lower cumulative waste per-use, increased emissions due to energy-intensive reprocessing. For ureteroscopes, single-use devices generated less CO2 but significantly more solid waste. TURBT procedures had a high carbon footprint (131.8 kg CO2 per procedure), largely from single-use items and sterilization. Robotic prostatectomy produced a lower carbon footprint (47,313 g CO2) than laparoscopic methods, emphasizing the potential for energy-efficient techniques to reduce emissions in urology. Conclusion: A hybrid approach in urology, focusing on improving sterilization processes and developing eco-friendly single-use alternatives, may provide a balanced approach toward sustainability.