gms | German Medical Science

24. Jahrestagung des Netzwerks Evidenzbasierte Medizin e. V.

Netzwerk Evidenzbasierte Medizin e. V. (EbM-Netzwerk)

22. - 24.03.2023, Potsdam

Environmental and human health impact of flexible ureterorenoscopy – analysis of intra-clinical aspects for life-cycle assessment

Meeting Abstract

  • Marlene Thöne - Universitätsklinikum Tübingen, Klinik für Urologie, Tübingen, Deutschland
  • Jan Lask - Universität Hohenheim, Fachgebiet für Nachwachsende Rohstoffe in der Bioökonomie, Deutschland
  • Jörg Hennenlotter - Universitätsklinikum Tübingen, Klinik für Urologie, Tübingen, Deutschland
  • Arnulf Stenzl - Universitätsklinikum Tübingen, Klinik für Urologie, Tübingen, Deutschland
  • Steffen Rausch - Universitätsklinikum Tübingen, Klinik für Urologie, Tübingen, Deutschland

Gesundheit und Klima – EbM für die Zukunft. 24. Jahrestagung des Netzwerks Evidenzbasierte Medizin. Potsdam, 22.-24.03.2023. Düsseldorf: German Medical Science GMS Publishing House; 2023. Doc23ebmPSI-2-03

doi: 10.3205/23ebm028, urn:nbn:de:0183-23ebm0288

Published: March 21, 2023

© 2023 Thöne et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background/research question: Climate change is a global challenge and health systems are relevant contributors to CO2 emissions. Therefore, concepts of Planetary Health have been implemented into urological practice. Earlier studies have specifically focused on Life Cycle Assessment (LCA) of single-use or reusable flexible ureterorenoscopes (fURS). The methodology used is highly data-dependent and knowledge on intra-hospital emissions is still limited. Here, we present a methodical approach for intra-institutional processes of LCA for fURS.

Methods: LCA was performed to assess the CO2 equivalents of reusable fURS (use-phase, maintenance, disposal) to approximate the Global Warming Potential (GWP) per use. Associated Human Health Impacts were evaluated using the impact assessment method ReCiPe2016(H) and Disability-adjusted Life Years (DALYs). Data were supplemented by systematic interviews of intra- and extra-clinical experts using likert-scaled questionnaires.

Results: Assuming 200 usages per fURS and maintenance after each 11th use, 7.3 kg CO2-eq equal to 6,7E-06 DALYs resulted for one application of a fURS. Most influential parameters were electricity required per refurbishment and per use. Qualitative assessment revealed a high relevance of clinical efficiency (5/5 "very high relevance") and results from clinical studies (4/5 "high relevance") for purchase decisions. Geographical criteria and trading conditions (0/5 "no relevance at all") were regarded as negligible while ecological criteria had medium relevance (3/5) in purchase decisions.

Conclusion: Electricity required for refurbishment and use are identified as crucial parameters of the CO2 footprint and health impact of fURS. Ecological criteria are gaining importance for purchase decisions of fURS. More comprehensive LCA for the human and planetary health impact of single-use and reusable fURS is planned based on these data. This study may act as a basis for similar analyses and provide research in the field of climate change and health with stronger evidence.

Competing interests: keine