A cradle-to-grave life-cycle assessment has been undertaken of the greenhouse gas emissions from the transurethral resection of bladder tumour (TURBT) pathway. The median carbon footprint of perioperative TURBT was 131.8  kg of CO2 equivalent. Multiple modifiable hotspots were found, including minimizing avoidable patient travel, rationalizing equipment use, optimally filling operating theatre lists and safely avoiding postoperative catheterization and hospital admission when possible. Implementing sustainable changes will improve the environmental credentials of this surgery.