Abstract
Similar to the glacial melt incurred by escalating climate change, I realize that I am trapped in the glorious past in which craftsmanship, quality of production, and longevity of product were paramount. Once pioneer now morphing into a Luddite of sorts, I rue the passing of this age and its replacement by expediency, disposability, and profit.
The findings in the well-done article by Hogan and colleagues 1 clearly show the potential benefits of the disposable cystoscope with regard to addressing, even to a small degree, the inexorable climate change that now is much upon us. Although one may nitpick about the use of a durable vs disposable plastic packing for the reusable cystoscope, the authors have nicely corroborated that the disposable single-use cystoscope has a lower carbon footprint. No matter how counterintuitive this seems, as in 2000 single-use cystoscopes vs 12 reusable cystoscopes for a year of cystoscopy at the authors' institution, the deal is sealed by the much higher carbon footprint incurred by the resterilization process. Indeed, the 10-fold difference in the sterilization carbon footprint (3.5 vs 0.3 kg CO2) because of its absolute amount more than swamps out the more than 1000-fold difference in the manufacturer's carbon footprint of the single-use vs the reusable cystoscope (1.82 vs 0.013 kg CO2).
The challenges of a shrinking conscientious labor force and the ever-rising repair costs of the reusable endoscope make the single-use entity attractive. To be sure, in the case of flexible ureteroscopy the carbon footprint has also been shown to be a bit less, with a cost-effectiveness that is reasonable (i.e., a $25 differential favoring the disposable ureteroscope if one includes the time saving noted at the authors' institution). 2 This appears to be a win-win situation.
Whether the same will hold true for the single-use cystoscope is still evolving; but given the more than 30-fold difference in durability of the reusable flexible cystoscope (on average 495 uses/repair) 3 vs its more asthenic cousin (i.e., the flexible ureteroscope with an average of only 15 uses/repair), 4 it may be hard to counterbalance the environmental benefits vs the potential negative cost-effectiveness, despite a lower cost for the disposable cystoscope (∼$150 vs upward of $1000 for the disposable ureteroscope), especially in practices performing upward of 2000 cystoscopies per year.
The times are changing … were it up to me I would focus on the repackaging and resterilization process and seek to reduce its carbon footprint and thus continue to keep the reusable cystoscope that has served me so well and so inexpensively throughout the years.