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Anract J, Pradere B, Pinar U. Sustainable practices in hospital and operating theaters. Curr Opin Urol 2024; 34:384-389. [PMID: 38813704 DOI: 10.1097/mou.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide an update on the results of studies published in the last two years involving the development of sustainable practices in hospital and operating theaters (OT). RECENT FINDINGS Recently, many studies evaluated various initiatives to better understand the environmental impact of the OT but also to minimize its environmental impact. Many trials evidenced the positive impact of the instrument's reuse using an appropriate reprocessing procedure. Better waste segregation is associated with a reduction of produced waste and contributes to a significant reduction in CO 2 equivalent emissions. Regarding anaesthetic gas, Desflurane is known to have the worst environmental impact and the majority of the study evidenced that its reduction permits to drastically reduce greenhouse gas emission of the OT. SUMMARY Greening the OT necessitates climate-smart actions such as waste reduction, the improvement of reusable instruments, recycling of our waste and better anaesthetic gas management. Within the last two years, many efforts have been made to reduce and better segregate waste produced in the OT and also to better understand the environmental impact of disposable and reusable devices.
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Affiliation(s)
- Julien Anract
- Université de Paris, APHP-Centre, Hôpital universitaire Cochin, Service d'urologie, Paris
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
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Woernle A, Moore CM, Allen C, Giganti F. Footprints in the scan: reducing the carbon footprint of diagnostic tools in urology. Curr Opin Urol 2024; 34:390-395. [PMID: 38847801 PMCID: PMC11309339 DOI: 10.1097/mou.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
PURPOSE OF REVIEW There is an ever-growing focus on climate change and its impact on our society. With healthcare contributing a sizeable proportion of carbon emissions, the sector has a duty to address its environmental impact. We highlight the recent progress, current challenges, and future prospects for reducing the carbon footprint in diagnostic urology, specifically for imaging, without compromising patient care. RECENT FINDINGS The review is separated into four key areas of recent research: the design of a green radiology department, considering both infrastructural as well as behavioural changes that promote sustainability; individual scanners, where we provide an update on recent technological advancements and changes in behaviour that may enhance sustainable use; responsible resource allocation, where it is important to derive the maximal benefit for patients through the smallest use of resources; the recent research regarding single versus reusable urologic endoscopes as a case example. SUMMARY We offer an overview of the present sustainability landscape in diagnostic urology with the aim of encouraging additional research in areas where existing practices may be challenged. To protect the environment, attention is drawn to both more simple steps that can be taken as well as some more complex and expensive ones.
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Affiliation(s)
- Alexandre Woernle
- Faculty of Medical Sciences
- Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
| | - Caroline M. Moore
- Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
- Department of Urology
| | - Clare Allen
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Francesco Giganti
- Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
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Bhattu AS. Editorial Comment on "Disposable Cystoscopes Do not Decrease Post Renal Transplant Stent Removal Symptomatic Infection Rates". Urology 2024:S0090-4295(24)00598-3. [PMID: 39053516 DOI: 10.1016/j.urology.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Amit S Bhattu
- Department of Urology, University of Pittsburgh Medical Center, Altoona, PA.
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Martins RS, Salar H, Salar M, Luo J, Poulikidis K, Razi SS, Latif MJ, Tafuri K, Bhora FY. Making minimally invasive procedures more sustainable: A systematic review comparing the environmental footprint of single-use versus multi-use instruments. World J Surg 2024. [PMID: 39030768 DOI: 10.1002/wjs.12286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Healthcare systems contribute 5%-10% of the global carbon footprint. Given the detrimental impact of climate change on population health, health systems must seek to address this environmental responsibility. This is especially relevant in the modern era of minimally invasive procedures (MIP) where single-use instruments are increasingly popular. We compared the environmental footprint of single-use versus multi-use instruments in MIP. METHODS We conducted a systematic review across five databases to identify relevant original studies, following the PRISMA guidelines. We extracted environmental impact data and performed a quality assessment of included studies. RESULTS We included 13 studies published between 2005 and 2024. Eight employed Life Cycle Analysis (LCAs), which is the gold standard methodology for studies evaluating environmental impact. The instruments studied included laparoscopy systems, endoscopes, cystoscopes, bronchoscopes, duodenoscopes, and ureteroscopes. Six studies, including three high quality LCAs and one fair quality LCA, showed that single-use instruments have a significantly higher environmental footprint than their multi-use counterparts. Six studies suggested a lower environmental footprint for single-use instruments, and one study presented comparable results. However, these studies were of poor/fair quality. CONCLUSION Although our systematic review yielded mixed results, all high quality LCAs suggested multi-use instruments may be more environmentally friendly than their single-use counterparts. Our findings are limited by inter-study heterogeneity and methodological quality. There is an urgent need for additional research employing gold standard methodologies to explore the interplay between environmental impact and operational factors such as workflow efficiency and cost-benefit ratio to allow health systems to make more informed decisions.
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Affiliation(s)
- Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian Health Network, Edison, New Jersey, USA
| | - Hashim Salar
- Medical College, Aga Khan University, Karachi, Sindh, Pakistan
| | - Musa Salar
- Medical College, Aga Khan University, Karachi, Sindh, Pakistan
| | - Jeffrey Luo
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian Health Network, Edison, New Jersey, USA
| | - Kostantinos Poulikidis
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian Health Network, Edison, New Jersey, USA
| | - Syed Shahzad Razi
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian Health Network, Edison, New Jersey, USA
| | - M Jawad Latif
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian Health Network, Edison, New Jersey, USA
| | - Kyle Tafuri
- Sustainability, Hackensack Meridian Health Network, Edison, New Jersey, USA
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian Health Network, Edison, New Jersey, USA
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Lawaczeck L, Rudolph J, Norz V, Tsaur I, Rausch S. The role of planetary health in urologic oncology. Expert Rev Anticancer Ther 2024; 24:513-523. [PMID: 38709157 DOI: 10.1080/14737140.2024.2350631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Climate change and global warming are an omnipresent topic in our daily lives. Planetary health and oncology represent two critical domains within the broader spectrum of healthcare, each addressing distinct yet interconnected aspects of human well-being. We are encouraged to do our part in saving our planet. This should include the decisions we make in our professional life, especially in uro-oncology, as the healthcare sector significantly contributes to environmental pollution. AREAS COVERED There are many aspects that can be addressed in the healthcare sector in general, as there are structural problems in terms of energy consumption, water waste, therapeutic techniques, transportation and drug manufacturing, as well as in uro-oncology specific areas. For example, the use of different surgical techniques, forms of anesthesia and the use of disposable or reusable instruments, each has a different impact on our environment. The literature search was carried out using PubMed, a medical database. EXPERT OPINION We are used to making decisions based on the best outcome for patients without considering the impact that each decision can have on the environment. In the present article, we outline options and choices for a more climate-friendly approach in urologic oncology.
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Affiliation(s)
- Laura Lawaczeck
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Julia Rudolph
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Valentina Norz
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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Bertolo R, Gilioli V, Veccia A, Malandra S, Dal Corso L, Fenzi D, Mazzetto F, Antonelli A. Institutional Micro-Cost Comparative Analysis of Reusable vs Single-use Cystoscopes With Assessment of Environmental Footprint. Urology 2024; 188:70-76. [PMID: 38499187 DOI: 10.1016/j.urology.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/18/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To conduct a comparative cost analysis between single-use and reusable cystoscopes from a national healthcare system perspective and assess the environmental footprint. METHODS Single-center micro-cost analysis of reusable vs single-use cystoscopes used institutional data. The cost breakdown included capital, reprocessing, repair, procedure, and environmental impact expenses. Data collection occurred in 2022, utilizing registered data, observations, and expert opinions. Depreciation was applied over 5 years for reusable cystoscopes and 8 years for the automated endoscope reprocessor. Deterministic sensitivity analyses gauged result robustness to input variations. Lastly, an assessment of the environmental footprint, focusing on water consumption and waste generation, was conducted. RESULTS Per-procedure cost associated with reusable cystoscopes was €332.46 vs €220.19 associated with single-use, resulting in savings of €112.27. When projecting these costs per procedure with the number of procedures performed in 2022 (1186), comparing the costs of procedures performed in 1 year with reusable endoscopes (€394,295.86) to the costs of the exact number of procedures performed with disposable endoscopes (€261,149.37), a saving of €133,146.49 could be achieved. Additionally, after continuous use of single-use endoscopes, procedures were scheduled every 20 minutes instead of every 30 minutes. This adjustment allowed for 15 daily procedures instead of 10 while maintaining the same shift. This suggests potential advantages in terms of improved organizational impact and reduced waiting lists. Ultimately, the decreased environmental impact favored the adoption of single-use cystoscopes. CONCLUSION Our study presents an opportunity for organizational development in response to the evolving external environment, considering user needs, market dynamics, and competition with other facilities.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy.
| | - Veronica Gilioli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy
| | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy
| | - Sarah Malandra
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy; Residency Program in Health Statistics and Biometrics, University of Verona, Verona, Italy
| | - Luca Dal Corso
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy
| | - Daniela Fenzi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy
| | - Francesca Mazzetto
- Unit of Management Control, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy
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Sharif K, de Santiago ER, David P, Afek A, Gralnek IM, Ben-Horin S, Lahat A. Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape. Lancet Gastroenterol Hepatol 2024; 9:550-563. [PMID: 38554732 DOI: 10.1016/s2468-1253(23)00414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 04/02/2024]
Abstract
Gastrointestinal practices, especially endoscopy, have a substantial environmental impact, marked by notable greenhouse gas emissions and waste generation. As the world struggles with climate change, there emerges a pressing need to re-evaluate and reform the environmental footprint within gastrointestinal medicine. The challenge lies in finding a harmonious balance between ensuring clinical effectiveness and upholding environmental responsibility. This task involves recognising that the most significant reduction in the carbon footprint of endoscopy is achieved by avoiding unnecessary procedures; addressing the use of single-use endoscopes and accessories; and extending beyond the procedural suites to include clinics, virtual care, and conferences, among other aspects of gastrointestinal practice. The emerging digital realm in health care is crucial, given the potential environmental advantages of virtual gastroenterological care. Through an in-depth analysis, this review presents a path towards sustainable gastrointestinal practices, emphasising integrated strategies that prioritise both patient care and environmental stewardship.
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Affiliation(s)
- Kassem Sharif
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERehd, ISCIII, Madrid, Spain
| | - Paula David
- Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - Arnon Afek
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Centre, Afula, Israel; Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sonaiya S, Marino R, Agollari K, Sharma P, Desai M. Environmentally sustainable gastroenterology practice: Review of current state and future goals. Dig Endosc 2024; 36:406-420. [PMID: 37723605 DOI: 10.1111/den.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES The health-care sector contributes 4.6% of global greenhouse gas emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal (GI) endoscopy. In this review, we aim to understand the carbon footprint in gastroenterology practice associated with GI endoscopy, conferences and recruitment, identify barriers to change, and recommend mitigating strategies. METHODS A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, inpatient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived. RESULTS This narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the United States is approximately 85,768 metric tons of CO2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per-case manufacturing carbon footprint for single-use devices and reusable devices is 1.37 kg CO2 and 0.0017 kg CO2, respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single-use items. Fellowship recruitment and gastrointestinal conferences added to the footprint, mainly due to air travel and hotel stays. CONCLUSION Gastrointestinal endoscopy and practice contribute to the carbon footprint through the use of disposables such as single-use endoscopes and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single-use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms such as telemedicine and research meetings should be implemented.
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Affiliation(s)
- Sneh Sonaiya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Richard Marino
- Kansas City University School of Medicine, Kansas City, USA
| | - Klea Agollari
- Kansas City University School of Medicine, Kansas City, USA
| | | | - Madhav Desai
- Center for Interventional Gastroenterology, UTHealth McGovern Medical School, Houston, USA
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Lam L, Bradbrook D, Gale J. Tracing the barriers to decarbonising ophthalmology: A review. Clin Exp Ophthalmol 2024; 52:78-90. [PMID: 38213078 DOI: 10.1111/ceo.14349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.
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Affiliation(s)
- Lydia Lam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Darren Bradbrook
- Surgery and Perioperative Medicine Division, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Southern Adelaide Local Health Network (SALHN), Bedford Park, South Australia, Australia
| | - Jesse Gale
- Department of Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
- Ophthalmology, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
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Ghorai RP, Kumar R. Reuse of Single-Use Devices in Endourology: A Review. J Endourol 2024; 38:68-76. [PMID: 37885229 DOI: 10.1089/end.2023.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Introduction: Single-use medical devices (SUDs) are labeled for single use only, but rising health care costs along with the absence of visible deterioration in the quality of SUDs after one use have led to their reprocessing and reuse. In the past, SUDs mainly consisted of equipment such as guidewires and catheters. However, SUDs have now expanded to flexible endoscopes and energy devices that are much more expensive. Reuse of such devices raises concerns of infection transmission, safety, and lack of effectiveness. We reviewed the disinfection process, cost benefits, potential harms, and legal status of the reuse of SUDs in endourology. Materials and Methods: PUBMED, Embase, and the Cochrane Library databases were searched for articles published between 1970 and March 2023 that reported the reuse of SUDs using the search terms "reuse"; "single-use device"; "disposable medical devices"; "reprocessing of single-use device"; "endourology"; and keywords related to cost, safety, sterilization, and legal status. Online resources were found using Google search engines. Articles on cost savings, device malfunction, disinfection, or legal status in different countries were reviewed. Results and Conclusions: Reusing SUDs has financial, environmental, and practical advantages. The potential savings on medical expenses is the most compelling argument for reprocessing disposable devices. Reusing medical equipment also contributes to the reduction of toxic biodegradable waste. However, there is a scarcity of data on the safety and efficacy of reused SUDs. For patient safety and to avoid complications, the practice must be regulated with established reprocessing standards.
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Affiliation(s)
- Rudra Prasad Ghorai
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Anderson S, Patterson K, Skolarikos A, Somani B, Bolton DM, Davis NF. Perspectives on technology: to use or to reuse, that is the endoscopic question-a systematic review of single-use endoscopes. BJU Int 2024; 133:14-24. [PMID: 37838621 DOI: 10.1111/bju.16206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To compare clinical outcomes of single-use endoscopes with those of reusable endoscopes to better define their role within urology. METHODS A systematic search of electronic databases was performed. All studies comparing the clinical outcomes of participants undergoing urological procedures with single-use endoscopes to those of participants treated with reusable endoscopes were included. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. RESULTS Twenty-one studies in 3943 participants were identified. Six different single-use flexible ureteroscopes and two different single-use flexible cystoscopes were assessed. There were no differences in mean postoperative infection rates (4.0% vs 4.4%; P = 0.87) or overall complication rates (11.5% vs 11.9%; P = 0.88) between single-use and reusable endoscopes. For patients undergoing flexible ureteroscopy there were no differences in operating time (mean difference -0.05 min; P = 0.96), length of hospital stay (LOS; mean difference 0.06 days; P = 0.18) or stone-free rate (SFR; 74% vs 74.3%; P = 0.54) between the single-use and reusable flexible ureteroscope groups. CONCLUSION This study is the largest to compare the clinical outcomes of single-use endoscopes to those of reusable endoscopes within urology, and demonstrated no difference in LOS, complication rate or SFR, with a shorter operating time associated with single-use flexible cystoscope use. It also highlights that the cost efficiency and environmental impact of single-use endoscopes is largely dependent on the caseload and reprocessing facilities available within a given institution. Urologists can therefore feel confident that whether they choose to 'use' or to 'reuse' based on the financial and environmental implications, they can do so without negatively impacting patient outcomes.
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Affiliation(s)
- Steven Anderson
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Damien M Bolton
- Department of Urology, Austin Hospital, Melbourne, VIC, Australia
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Herrmann A, van Veen FEE, Blok BFM, Watts KL. A Green Prescription: Integrating Environmental Sustainability in Urology Guidelines. Eur Urol Focus 2023; 9:897-899. [PMID: 38036340 DOI: 10.1016/j.euf.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
Against the background of the climate crisis, there is an urgent need to include environmental sustainability recommendations in clinical practice guidelines. We highlight five domains for which suitable recommendations could help in mitigating the environmental impact of urology practice. PATIENT SUMMARY: Climate change is an urgent issue that requires global action. Guidelines published by urological societies should include recommendations for minimizing the impact of urology practice on the environment.
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Affiliation(s)
- Alina Herrmann
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | | | | | - Kara L Watts
- Department of Urology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
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13
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Baboudjian M, Pradere B, Uleri A, Lechevallier E. Reuse and Reprocessing of Endoscopic Instruments: Con. Eur Urol Focus 2023; 9:859-860. [PMID: 37748949 DOI: 10.1016/j.euf.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
Reprocessing of endoscopic equipment generates greenhouse gas emissions, releases toxic substances into the environment, and consumes large quantities of water. The use of alternative materials, such as single-use devices with a low carbon footprint and recycled materials, and reprocessing without the use of water and toxic products represent sustainable solutions.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France.
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France; Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Alessandro Uleri
- Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - Eric Lechevallier
- Department of Urology, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France
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Koo K, Wymer KM, Potretzke AM. Reuse and Reprocessing of Endoscopic Instruments: For. Eur Urol Focus 2023; 9:857-858. [PMID: 38040525 DOI: 10.1016/j.euf.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
Reusable endoscopes appear to be most environmentally sustainable when the carbon footprint of routine device maintenance is optimized. Single-use endoscopes may offer cost-savings in clinical settings that accelerate device damage, such as prolonged procedure time or complex patient anatomy. For many urology practices, a hybrid approach that integrates single-use and reusable devices may be most economically sensible and environmentally sound.
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Affiliation(s)
- Kevin Koo
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
| | - Kevin M Wymer
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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Pandit K, Yodkhunnatham N, Bagrodia A, Monga M. Sustainability in Urology: Ideas for a Greener Future. Eur Urol Focus 2023; 9:894-896. [PMID: 37748950 DOI: 10.1016/j.euf.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
Sustainability in urology can be achieved via conscientious practices that minimize the negative impact of our services while achieving ethical and responsible patient care. We highlight novel and actionable ideas that could pave the path towards healthier, greener urological practice.
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Affiliation(s)
- Kshitij Pandit
- Department of Urology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Nuphat Yodkhunnatham
- Department of Urology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Aditya Bagrodia
- Department of Urology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Manoj Monga
- Department of Urology, University of California-San Diego School of Medicine, La Jolla, CA, USA.
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Baboudjian M, Bastide C, Lechevallier E. Comment on 'environmental impact of single-use and reusable flexible cystoscopes'. BJU Int 2023; 131:634. [PMID: 36820507 DOI: 10.1111/bju.15996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Michael Baboudjian
- Department of Urology, APHM, La Conception Hospital, Aix-Marseille University, Marseille, France.,Department of Urology, APHM, North Hospital, Aix-Marseille University, Marseille, France
| | - Cyrille Bastide
- Department of Urology, APHM, North Hospital, Aix-Marseille University, Marseille, France
| | - Eric Lechevallier
- Department of Urology, APHM, La Conception Hospital, Aix-Marseille University, Marseille, France
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