Staios Dimitrios, Andrews Henry O, Shaik Taufiq, Buchholz Noor N P
Endourology & Stone Service, Department of Urology, Barts & The London NHS Trust London, UK.
J Endourol. 2007 May;21(5):515-9. doi: 10.1089/end.2006.0432.
The treatment of caliceal diverticulum and deeply secluded lower-pole stones is challenging, and the indications are controversial. This study assessed the changes in the quality of life (QoL) of patients undergoing percutaneous nephrolithotomy (PCNL) for symptomatic caliceal diverticula and deep lower-pole calculi to determine whether there is a change in the "bother factor" in order to improve treatment strategies for this group of patients.
Twenty-two patients undergoing PCNL were evaluated prospectively using the SF36 QoL questionnaire before and 6 weeks after PCNL. The results before and after PCNL were compared individually and by group and analyzed statistically. A P value <or=0.05 was considered significant.
Most (87%) of the patients were completely stone free after the procedure. Significant QoL findings were a reduction in symptoms interfering with performance at work (40%) and improved general health (33%). Although there was an overall improvement in QoL across the entire group, this reached statistical significance for only two of the seven domains of the questionnaire.
In spite of a high stone-free rate, fewer than half of patients benefited subjectively from the procedure in terms of improvement of QoL. Therefore, patients should be made aware of the limited impact of surgical treatment on QoL, and asymptomatic patients can be given the option of further watchful waiting.
肾盏憩室及下极深部隐匿性结石的治疗具有挑战性，且治疗指征存在争议。本研究评估了因有症状的肾盏憩室和下极深部结石接受经皮肾镜取石术（PCNL）的患者的生活质量（QoL）变化，以确定“困扰因素”是否有变化，从而改进该组患者的治疗策略。
前瞻性地使用SF36生活质量问卷对22例行PCNL的患者在术前及术后6周进行评估。对PCNL前后的结果进行个体和分组比较，并进行统计学分析。P值≤0.05被认为具有统计学意义。
大多数（87%）患者术后结石完全清除。生活质量的显著改善包括影响工作表现的症状减少（40%）和总体健康状况改善（33%）。尽管整个组的生活质量总体有所改善，但在问卷的七个领域中只有两个领域达到了统计学意义。
尽管结石清除率很高，但从生活质量改善的角度来看，主观上受益于该手术的患者不到一半。因此，应让患者了解手术治疗对生活质量的影响有限，对于无症状患者可选择进一步观察等待。
