OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.