Comparative 30-day life cycle assessment of bladder drainage strategies.

Abstract

To identify the most environmentally sustainable urinary drainage strategies commonly used to manage bladder outlet obstruction and also to highlight actionable levers for reducing the footprint of urinary drainage in clinical practice. We conducted a comparative life cycle assessment of three urinary drainage strategies (i.e., indwelling urinary catheter, clean intermittent self-catheterisation [CISC], and temporary urethral stent) over a 30-day period, in accordance with International Organization for Standardization (ISO) 14040 and ISO 14044 standards. Primary data were collected via device disassembly and manufacturer consultation, with secondary data from the Ecoinvent version 3.9 database (Ecoinvent, Zurich, Switzerland). Impacts were modelled using the Environmental Footprint 3.0 method across 13 categories. Sensitivity analyses tested care delivery parameters and reusable catheters for CISC. The mean climate change impact over 30 days was 96.5 kg CO₂ equivalents (CO₂-eq; 95% confidence interval [CI] 58.8-162) for indwelling catheterisation, 39.8 kg CO₂-eq (95% CI 31.2-53.3) for disposable CISC catheters, and 16.1 kg CO₂-eq (95% CI 8.4-29.2) for the stent. Indwelling catheterisation consistently showed the highest impact, CISC intermediate, and the stent the lowest. Relative to catheterisation, the stent reduced climate impact by 83%, fossil resource use by 83%, and water consumption by 92%. Reusable CISC catheters showed a comparable profile to the stent. Sensitivity analyses confirmed that home nurse travel, device replacement frequency, and patient autonomy substantially influenced overall impact. Limitations include the mono-country design. Device choice and care delivery models critically affect the environmental footprint of urinary drainage strategies. This study provides further strong arguments for promoting existing alternatives to the indwelling urinary catheter.