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When Less Is More: Assessing Irrigant and Plastic Waste During Endoscopic Urologic Surgeries
Austin Freedman, BS, So Yeon Pak, MD, Ilir Agalliu, MD, ScD, Alexander Small, MD, Dima Raskolnikov, MD, Kara Watts, MD.
Albert Einstein College of Medicine, NEW YORK, NY, USA.
BACKGROUND: In 2024, Hurricane Helen created a national shortage of sterile irrigation and intravenous fluids, highlighting the need for resource optimization. Healthcare contributes significantly to environmental waste and carbon emissions. This study assessed utilization and waste of irrigant fluids and plastic packaging during urologic endoscopic surgeries.
METHODS: We prospectively reviewed surgeries from September to December 2025 at a single institution: ureteroscopy (URS), transurethral resection of bladder tumor (TURBT), cystoscopy stent exchange, direct vision internal urethrotomy (DVIU), and cystoscopy with bladder biopsy. Patient demographics were recorded. For URS cases, laterality, total stone length, and number treated were recorded. Irrigation volume opened and discarded after each procedure was recorded. Plastic waste from irrigant bags was calculated based on wasted fluid volumes. Univariable and multivariable median regressions identified predictors of increased fluid use.
RESULTS: 55 unilateral URS, 10 bilateral URS, 14 TURBT, 13 cystoscopy stent exchange, 5 DVIU, and 4 cystoscopy bladder biopsy were analyzed. Median volume opened per procedure was 6 L (range: 1 - 12 L); median volume used was 1300 mL (range: 100 - 9000 mL). Total and median volumes wasted were 372 L and 3683 mL (range: 0 - 9200 mL), with 68% of fluids wasted. Fluids came from 3 L (80%), 1 L (12%), and 2 L (8%) bags. Highest fluid waste occurred in cystoscopy stent exchange (86%). Plastic waste totaled 20.5 lbs. Male gender (p = 0.03) predicted increased fluid use.
CONCLUSIONS: All endoscopic urologic surgeries require irrigation fluid, and any fluid/plastic waste can have a considerable impact over time. Hospitals and Urologists should adopt conservative fluid strategies. A single 2 L bag would be sufficient for 75.3% of endoscopic urology cases.
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