gms | German Medical Science

Background/research question: One of the most common outpatient procedures in urology is cystoscopy, for which the flexible cystoscope is an important diagnostic tool. Since their introduction in the 1970s, reusable cystoscopes have undergone steady development, but ongoing costs in particular for device processing, as well as sterilization errors and repairs, pose challenges for smaller facilities [1]. The manufacturers of a new disposable device advertise the elimination of costs for reprocessing, which is complex and additionally subject to external quality controls.

Methods: Focused information gathering was applied.

Results: In their analysis comparing the environmental footprint of disposable and reusable flexible cystoscopes, Hogan et al. conclude that the environmental impact of reusable flexible cystoscopes is significantly greater than that of disposable cystoscopes when a fleet of devices is used [2]. This is contradicted by the results of the lifetime analysis of another group of researchers and a further analysis of the methodological approach [1], [3]. Even from the perspective of sustainability and corporate and medical responsibility, the conclusion for rural clinics and individual practices cannot be that disposable cystoscopes are more economically and ecologically efficient [3]. On the contrary, the amount of medical waste generated and the environmental impact of manufacturing, transporting, using, and disposing of a new product for one of the most commonly performed procedures in urology should drive manufacturers and hygiene regulators to develop and accept alternative and more efficient reprocessing methods. Energy consumption for automatic reprocessing of reusable cystoscopes should be compensated by renewable energy sources and solutions for central reprocessing should be found such as collection and re-delivery of processed cystoscopes for resource-limited clinical settings by couriers or drones following the model of drone-assisted delivery of medical goods.

Conclusion: Our example shows the urgent need to standardise the methods for environmental impact assessment in order to prevent easily possible manipulations as well as to better inform decision makers based on reliable data.

Competing interests: None