ArticleEuropean urology open science2026
Life Cycle Assessment of HoLEP: Quantifying Environmental Impact and Opportunities for Sustainable Urologic Surgery.
Article in European urology open science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
Background: The healthcare sector faces growing pressure to reduce its environmental impact. In urology, Holmium Laser Enucleation of the Prostate (HoLEP) is a standard treatment for benign prostatic obstruction (BPO), but its procedure-related environmental impact remains unknown. Objective: We aimed to quantify HoLEP's life cycle environmental impacts, identify major environmental hotspots, and evaluate the impact of a fluid management system developed according to sustainable-by-design principles. Design setting and participants: We conducted a cradle-to-grave life cycle assessment (LCA) of 20 consecutive HoLEP procedures, following ISO 14040/44 standards and the European Product Environmental Footprint (PEF) methodology. ISO 14040/44 allowed us to structure the study while the 16 PEF indicators ensure comparability with other European medical devices. All perioperative phases (pre-, intra-, and post-operative) were included, encompassing medical devices, consumables, energy use, and waste streams. Outcome measurements and statistical analysis: Environmental impacts were modeled using SimaPro v9.6 with the Ecoinvent database. Primary outcomes were the PEF score and the carbon footprint (CF). Environmental performance was compared between the 10-L fluid collection canisters and the SUPER S.HO.W. fluid management system. Statistical analyses used non-parametric tests, with significance set at Results and limitations: The median PEF score per HoLEP procedure was 5.9 points (interquartile range [IQR]: 5.7-6.1), with a CF of 106 kg CO Conclusions: HoLEP generates quantifiable life cycle environmental impacts. Optimizing surgical workflows and implementing innovative solutions-such as the closed-circuit SUPER S.HO.W. system-significantly reduce the environmental impact of endourological procedures.
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