Proposal for Standardization of Medical Institution Evaluation Based on Experience in Endoscopic-combined Intrarenal Stone Surgery

Giant urinary stones at the renal pelvis-ureteral junction (PUJ) are usually difficult to remove with retrograde intrarenal surgery due to deformation of the ureter, requiring endoscopic-combined intrarenal stone surgery. In order to choose a medical institution to perform this highly difficult surgery, the patient should consider whether the hospital has an appropriate level of X-ray and CT equipments to treat this PUJ stone and whether the medical staff has sufficient experience to perform the surgery. In this paper, we report on the process of choosing a surgical hospital after visiting and consulting at three different level of medical institutions (a university hospital, a general hospital, and a private clinic) for PUJ stone removal surgery. The university hospital was well equipped with the medical devices needed for surgery and had enough experience of the surgery, but it did not sufficiently explain the test and surgery procedures to the patient, and did not take the patient's convenience into consideration at all when deciding on the surgery schedule. On the other hand, in a clinic with well-equipped surgical facilities, the patient's pain was given priority, the examination and surgical procedures were explained in detail, and the surgical schedule was also decided in consultation with the patient. When choosing a medical institution to undergo a difficult surgery, not only the facilities and surgical experience of the medical institution, but also the communication and attitude of the medical staff with the patient were important factors. Through this experience, we propose a method of evaluating medical institutions in which medical experts participate from the patient's perspective, and also recommend that private clinics with sufficient facilities and personnel be included in the designation of specialized hospitals.