• Mudassir Wani, Sanjeev Madaan, Gareth Brown, Martin Steggall, and Ghulam Nabi.
• Department Of Urology, Cardiff, and Vale University Health Board, Cardiff, UK.
• Scot Med J. 2024 Aug 1; 69 (3): 889888-98.

ObjectivesTo systematically synthesize existing reported literature calculating the carbon footprint (CFP) of urological surgical practice and identify opportunities for improving the environmental impact of urology surgical practice.MethodsA systematic review was performed following PRISMA guidelines. The Cochrane, Embase, Ovid MEDLINE, and PubMed were searched between 1971 and 2023, with inclusion and exclusion criteria. The outcome measures were mapped across the included studies including assessment of risk of bias.ResultsA total of 345 studies with titles were identified from an initial search, however only 5 were included. Three studies compared singleuse with reusable cystoscopes concluded that single-use cystoscopes are non-inferior to reusable cystoscopes environmentally due to the carbon footprint associated with decontamination and repackaging. Similarly, in a single study, the CFP of single-use and reusable ureteroscopes is comparable. Lastly, a single study concluded that robotics-assisted surgery in prostate cancer may be a better option than other approaches in terms of environmental sustainability.ConclusionsIn conclusion, although minimally invasive (including robotic approaches) and endoscopic surgeries offer significant opportunities to improve healthcare we do need to consider the environmental impact. However, there is a paucity of good-quality literature to guide urological surgical practice to reduce the CFP and improve sustainability.

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