Supine Tubeless PCNL for Large Kidney Stones in Maine

What it is

Percutaneous nephrolithotomy — PCNL — is the most invasive of the stone surgeries, reserved for the largest and most complex kidney stones: staghorn stones, stones generally larger than 2 cm, and stones in locations other techniques cannot reach. A small tract (under 1 cm) is made through the skin of the back into the kidney, and the stones are broken up and removed under direct vision with a nephroscope and laser or lithotripter.

First, ask whether ureteroscopy is an option

The need for PCNL is narrowing. Vacuum-assisted ureteroscopy — which Dr. Ursiny offers — can now clear many larger stones that once required PCNL, with no incision in the back and a faster recovery. For most stones it is worth asking whether ureteroscopy can do the job first. Learn about ureteroscopy with vacuum aspiration →

When PCNL is the right choice, two refinements make it safer and more comfortable than it used to be:

Supine positioning

Historically PCNL was done with the patient lying face-down (prone). Modern supine PCNL places the patient on their back, slightly tilted — which is gentler on the airway during anesthesia and more comfortable during recovery.

Tubeless / no external tube

Historically a nephrostomy tube — a drain exiting through the skin of the back — was left in place for days after PCNL. In appropriate cases, Dr. Ursiny leaves no external tube. "Tubeless" does not mean nothing is left behind: an internal ureteral stent, entirely inside the body, is still placed, and it is removed at a brief office visit about a week later. What you avoid is an external drain to manage at home — so recovery is more comfortable, with less pain.

Who it is for

Kidney stones over about 2 cm
Staghorn or partial staghorn stones
Stones in difficult-to-reach locations (e.g., lower-pole stones with unfavorable anatomy)
Stones that failed ureteroscopy or shockwave lithotripsy

What the day looks like

General anesthesia. Operative time generally 1.5 to 3 hours depending on stone burden. PCNL involves an overnight hospital stay. Most patients are walking within hours and home the next morning.

Recovery

Hospital stay: one overnight
Desk work: 1–2 weeks
Full activity: 2–4 weeks
The internal ureteral stent is removed in a brief office procedure, typically about one week later
Stone-free rates with modern PCNL are 85–95% in a single operation

Risks worth knowing

PCNL is an effective operation, but it is real surgery on the kidney, and its risks are higher than those of ureteroscopy. They are worth understanding honestly:

Bleeding — PCNL carries a meaningful bleeding risk; roughly 2–7% of patients need a blood transfusion. Uncommonly (on the order of 1%), bleeding is severe enough to require an emergency angiographic embolization to control it — a serious complication, not a minor one.
Infection — including the possibility of a bloodstream infection (sepsis); reduced but not eliminated by a pre-operative urine culture and targeted antibiotics
Injury to an adjacent organ — the lung or the bowel can be injured during access, each on the order of 1%
Residual stone fragments — possible with large or staghorn stones; may require a second procedure

These risks are a large part of why, whenever a stone can be cleared effectively with vacuum-assisted ureteroscopy instead, that less invasive route is usually preferable.

And after the stone is out

For anyone forming stones large enough to require PCNL, a metabolic workup to understand why is part of the plan. Blood work, a 24-hour urine, and an updated assessment of diet and fluids identify what to change so this becomes a one-time event rather than a recurring one.

Supine, tubeless PCNL.