263 - Understanding the Full Picture of Environmental Impact and Single-use Ureteroscopy

Description:

Introduction: As the utilization of single-use (SU) endoscopes continues to grow across specialties, including urology, so too has the emphasis on understanding the environmental impact of these disposable devices. A 2023 study by Haislip et al. surveyed urologists across the United States (U.S.) and identified "environmental impact coming from single-use ureteroscopes" as a main barrier to utilizing SU. As a result of this growing emphasis, research comparing reusable (RU) and SU endoscopy practices has become more prominent, governing bodies and health systems have begun instituting sustainability initiatives, and manufacturers have implemented materials changes aimed at mitigating overall impact. This study aimed to identify the awareness of ongoing sustainability efforts across urology facilities in the U.S.

Methods: To evaluate the awareness of ongoing sustainability efforts across healthcare facilities and manufacturers, 87 board-certified urologists and 16 clinical administrators were surveyed in the U.S. from December 2023 through June 2024. Survey questions focused on barriers to and drivers of single-use adoption, awareness of environmental metrics in healthcare facilities, bioplastics used in manufacturing and recycling programs for single-use. Results were analyzed and proportions of responses were calculated.

Results: Of the 16 administrators, 67% indicated their current facility does not have an environmental metric in place. In regards to urologists, only 45% of respondents were aware of bioplastics, while most (76%) indicated an interest in a recycling program for SU endoscopes. Additionally, the main barriers to single-use utilization from the urologist perspective included the environmental impact, cost and image quality of single-use scopes.

Conclusion: The environmental concern around increased SU endoscope utilization is a major barrier to SU endoscope adoption in the U.S., despite clinical and workflow advantages that may be presented by a SU platform. Although this concern has grown across healthcare, more than half of respondents noted their facility did not have an environmental metric in place at that time. In terms of waste generation, which is at the forefront of this topic, published literature shows SU endoscopy produces less waste mass than RU endoscopy, which is driven by the reprocessing of RU. Additionally, SU endoscopy has shown to consume less water per procedure compared to RU endoscopy. Publications reviewing the entire life cycle of both SU and RU urological endoscopes, from material procurement through end of life of the scope, found comparable environmental footprints. It is of note, SU manufacturers have begun incorporating bioplastics into their production of their endoscope handles and reducing the overall carbon footprint of scope handle production, which may have not been considered in these recent publications. Physicians and facilities should continue to investigate the environmental impacts of all endoscopic practices, while developing quantifiable environmental metrics that are aimed at tracking total mass waste generation and water consumption within their system.