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Urology on a changing planet: links between climate change and urological disease

Nature Reviews Urology volume 22, pages 208–222 (2025)Cite this article

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Abstract

Urological diseases and their varied forms of management warrant special attention in the setting of climate change. Regarding urological cancers, climate change will probably increase the incidence and severity of cancer diagnoses through exposures to certain environmental risk factors, while simultaneously disrupting cancer care delivery and downstream outcomes. Regarding benign urological diseases, a burgeoning body of work exists on climate-related heat waves, dehydration, urolithiasis, renal injury and infectious and vector-borne diseases. Adding to the potential effect on disease pathogenesis, many patients with urological diseases undergo high-tech, resource-intensive interventions, such as robotic surgery, and entail intensive longitudinal assessments over many years. These features incur a considerable carbon footprint, generate substantial waste, and can introduce vulnerabilities to climate-related weather events. Links exist between planetary health (the health of humans and the natural systems that support our health), climate change and urological disease and urological care providers face many challenges in the era of anthropogenic climate change. The next steps and priorities for research, management, and health care delivery include identification and prioritization of health care delivery strategies to minimize waste and carbon emissions, while supporting climate resilience. Examples include supporting telemedicine, limiting low-value care, and building resilience to minimize impacts of climate-related disasters to prepare for the challenges ahead.

Key points

  • Climate change could influence risks for many benign and malignant urological conditions, including through air pollution, wildfires and water contamination.

  • Epidemiological research on air and water pollution, temperature and chemical exposures can inform research, clinical and health policy priorities for urological research.

  • The effects of climate change will probably disrupt the quality of urological care with interruptions to medical supply chains, hospital closures and damage, and fragmentation of care.

  • Early warning systems targeting populations and facilities that are vulnerable to climate impacts are crucial and can help to support health care resilience.

  • Improving the environmental sustainability of urology care delivery — a surgical subspecialty that produces high carbon emissions through complex, resource-intensive care and frequent intensive evaluations — could help to mitigate the climate impacts of the health care sector.

  • Priority areas and next steps include further clarifying epidemiological links between climate change and disease pathogenesis to identify opportunities for interventions; implementing and evaluating policies that support more environmentally sustainable and resilient health systems; and research on how to eliminate low-value, environmentally harmful urological care practices.

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Fig. 1: Pathways connecting climate change and urological disease.
Fig. 2: Policy and research domains for urology in the warming planet.

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Authors and Affiliations

  1. Department of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Alexander P. Cole, Zhiyu Qian, Hanna Zurl & Quoc-Dien Trinh

  2. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Alexander P. Cole, Zhiyu Qian, Hanna Zurl & Quoc-Dien Trinh

  3. Department of Urology, New York University Langone Health, New York, NY, USA

    Natasha Gupta & Stacy Loeb

  4. Department of Population Health, New York University Langone Health, New York, NY, USA

    Natasha Gupta & Stacy Loeb

  5. Department of Surgery/Urology, Manhattan Veterans Affairs, New York, NY, USA

    Natasha Gupta & Stacy Loeb

  6. Department of Urology, Yale School of Medicine, New Haven, CT, USA

    Michael Leapman

  7. Department of Urology, Medical University of Graz, Graz, Austria

    Hanna Zurl

  8. Department of Anaesthesiology, Yale School of Medicine; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA

    Jodi D. Sherman

  9. Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute, New Brunswick, NJ, USA

    Hari S. Iyer

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A.P.C. researched data for the article. All authors contributed substantially to discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission.

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Correspondence to Alexander P. Cole.

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Q.D.T. reports personal fees from Astellas, Bayer, Intuitive Surgical, Janssen, Novartis and Pfizer, outside the submitted work. Q.D.T. reports research funding from the American Cancer Society, the Defense Health Agency and Pfizer Global Medical Grants. S.L. reports consulting with Astellas and Doceree, unrelated to the current manuscript. A.P.C. reports research funding from the American Cancer Society and Pfizer Global Medical Grants and proctoring fees from EDAP/Focal One. The funders were not involved in the writing of this manuscript. The other authors declare no competing interests.

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Cole, A.P., Qian, Z., Gupta, N. et al. Urology on a changing planet: links between climate change and urological disease. Nat Rev Urol 22, 208–222 (2025). https://doi.org/10.1038/s41585-024-00979-4

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