The Environmental Impact of Cystoscopes - A Systematic Review and Quality Assessment of Life Cycle Assessments

INTRODUCTION: There’s a belief that reusable medical devices are better for the environment compared to disposable ones, yet there’s insufficient evidence to support this notion. While we must continue to deliver evidence-based practice, limiting healthcare greenhouse gas emissions is imperative to alleviating the impacts of climate change. We sought to provide a systematic literature review of studies conducting a Life Cycle Assessment (LCA) of single-use and reusable cystoscopes. This review marks the first attempt to assess the quality of published LCAs.

METHODS: Embase, PubMed, DTU Find-it, HealthcareLCA, and Google Scholar were searched for studies measuring the environmental impact of cystoscopes between 01.01.1990 and 01.04.2024. The review process adhered to PRISMA guidelines, and data extraction was performed independently by two reviewers. ISO 14044:2006 Environmental management — Life cycle assessment — Requirements and guidelines, §5.2, an international standard specifying requirements and providing guidelines for life cycle assessment (LCA), was used as a checklist to assess the quality of each LCA. Each study was scored between 0–2 for subcategories of 1) General aspects, 2) Goal of the study, 3) Scope of the study, 4) Life cycle inventory analysis, 5) Life cycle impact assessment, 6) Life cycle interpretation, and 7) Critical review, with 2 demonstrating full compliance with LCA standards.

RESULTS: 654 studies were identified, of which five studies sought to conduct an LCA. Four out of five studies found single-use cystoscopes to have a lower CO₂ footprint compared to reusable cystoscopes. The CO₂ footprint of single-use cystoscopes ranged from 1.43 kg CO₂e to 2.41 kg CO₂e, while the CO₂ footprint for reusable cystoscopes ranged from 0.53 kg CO₂e to 4.23 kg CO₂e. Results are shown in Table 1.

CONCLUSIONS: Single-use cystoscopes might provide a lower CO₂ footprint compared to reusable cystoscopes; however, there is a need for further LCAs conducted in accordance with ISO 14044.

FUNDING: None.

Access this article through the link below: Journal of Endourology, Vol. 38, No. S1, Page 135.