Impact of Percutaneous Nephrostomy on Pain, Quality of Life, Family Burden, and Depressive Symptoms: A Prospective Observational Study.

Objectives: To evaluate the impact of percutaneous nephrostomy (PN) on family burden, health-related quality of life (HRQoL), depressive symptoms, and pain, and to identify predictors of postoperative change. Methods: In this prospective study, 119 patients undergoing PN for obstructive uropathy were assessed before and after PN using the Visual Analog Scale (VAS), Beck Depression Inventory (BDI), EQ-5D-3L sum score, and Family Reported Outcome Measure-16 (FROM-16). Pre- and post-procedure differences were analyzed using the Wilcoxon signed-rank test, and multivariable linear regression was used to identify predictors of change (p<0.05). Results: The mean age was 61.7 years, and 64.7% of the patients were male. Malignancy was the most common etiology, followed by stone disease and benign strictures. All outcomes deteriorated after PN: FROM-16 increased from 7.39 to 15.87, EQ-5D-3L sum score from 7.45 to 13.71, BDI from 12.97 to 17.92, and VAS from 1.22 to 5.23 (all p<0.001). Malignancy, ureteral stricture, and infection were associated with smaller increases in family burden. Spousal caregiving was associated with greater HRQoL deterioration (p=0.020), whereas infection predicted less worsening. Older age was associated with greater increases in BDI, while longer marriage duration and unemployment were associated with smaller BDI changes (p<0.05). Pain worsening was less pronounced in male patients and those with higher education levels (p<0.05). Conclusion: Although PN relieves obstruction, it is associated with significant deterioration in psychosocial outcomes. Psychosocial screening and caregiver support should be integrated into PN care pathways to protect patient-centered outcomes.