Supine Percutaneous Nephrolithotomy (PCNL)

Supine Percutaneous Nephrolithotomy (PCNL) is a treatment usually reserved for larger stones in the kidney or upper ureter.

Key points

• Suitable for large or complex kidney stones
• Performed with the patient in the supine (face-up) position
• Requires general anaesthesia
• Procedure duration ranges from 2 to 2.5 hours
• 1-2 day hospital stay

Why choose Urocare?

At Urocare London, our commitment to excellence in urology is driven by the expertise and dedication of our leading specialist, Mr. Maneesh Ghei. Located at leading private hospitals in London, Urocare London offers the convenience and accessibility you need. 

What is Supine Percutaneous Nephrolithotomy (PCNL)?

Supine Percutaneous Nephrolithotomy (PCNL) is an advanced surgical technique designed to remove large or complex kidney stones. Performed with the patient in the supine position, this minimally invasive approach involves making a small incision in the back to allow direct access to the kidney and the stones.

The procedure employs the use of a nephroscope and other specialised instruments to locate and remove the stones. Supine PCNL is known for its effectiveness in treating large kidney stones and offers the advantage of a potentially shorter operation time and recovery period compared to the traditional prone PCNL.

Who is this treatment suitable for?

Supine PCNL is particularly suited for patients with large, complex kidney stones (larger than 2cm) that are difficult to treat with less invasive methods such as Ureteroscopy or Extracorporeal Shock Wave Lithotripsy (ESWL). It’s also an option for patients who have not had success with other stone removal techniques or who have anatomical issues that make other procedures less viable.

Is this a major operation?

Yes, supine PCNL is considered a major operation. It is performed under general anaesthesia and requires a hospital stay. However, it is less invasive than open surgery, with patients benefiting from smaller incisions, less pain, and quicker recovery times.

How long does the procedure take?

The duration of a supine PCNL procedure can vary but typically lasts between 2 to 2.5 hours, depending on the size and complexity of the kidney stones.

What to expect during the procedure

• Anaesthesia: General anaesthesia is administered to ensure the patient is asleep and pain-free during the procedure.
• Making the Incision: A small incision is made in the back, through which a nephroscope is inserted directly into the kidney.
• Stone Removal: The kidney stones are visualised with the nephroscope, and special instruments are used to fragment and remove the stones.
• Drainage: A nephrostomy tube may be placed temporarily to drain urine and residual stone fragments from the kidney.
• Post-Procedure: Patients are taken to a recovery area to be monitored as the anaesthesia wears off. Pain management and postoperative care instructions are provided.

Post-procedure care and recovery

After undergoing a Supine PCNL procedure, patients can expect a structured recovery process, typically involving:

• Hospital Stay: A 1-2 day hospital stay is common to monitor for any immediate postoperative complications and to manage pain.
• Pain Management: Pain at the incision site and discomfort from the procedure can be managed with prescribed pain medication. Pain management strategies are adjusted based on individual patient needs and responses.
• Activity Restrictions: Patients are usually advised to avoid strenuous activities and heavy lifting for 4-6 weeks post-procedure to allow the kidney and the site of the incision to heal properly. Light activities and walking are encouraged to promote circulation.
• Hydration: Drinking plenty of fluids is crucial after PCNL to help flush out any remaining stone fragments and to aid in the recovery of the urinary tract.
• Follow-up Care: Follow-up appointments are essential for removing any temporary stents placed during surgery, monitoring healing, and ensuring that all stone fragments have been eliminated. Imaging tests may be performed to check for residual stones.

Possible risks and complications

While Supine PCNL is a safe and effective procedure for removing large or complex kidney stones, it does come with potential risks and complications, including:

• Bleeding: The procedure can cause bleeding, which in rare cases, may require a blood transfusion.
• Infection: There’s a risk of urinary tract infections or, more rarely, sepsis. Preventive antibiotics are often administered to mitigate this risk.
• Injury to Surrounding Organs: Though uncommon, there is a risk of injury to organs near the kidney, such as the liver, spleen, or intestines, during the procedure.
• Residual Stones: Some patients may have stone fragments that were not removed during the procedure, potentially requiring additional treatment.

Alternative treatments

For patients seeking alternatives to Supine PCNL, or for whom Supine PCNL may not be the most suitable option, there are several other treatments available:

Extracorporeal Shock Wave Lithotripsy (ESWL)

A non-invasive procedure that uses shock waves to break kidney stones into smaller pieces that can be passed in the urine. Best suited for small to medium-sized stones.

Ureteroscopy and Holmium Laser Lithotripsy

A minimally invasive technique where a small scope is inserted through the urethra and bladder into the ureter or kidney, and a laser is used to break up the stones. Suitable for stones in the ureter or kidney that are not excessively large.

Medical Management

Some small stones can be managed with medication to help them pass or to alleviate symptoms, along with dietary and fluid intake modifications to prevent further stone formation.

Frequently asked questions

Why is the supine position preferred for some PCNL procedures?

The supine position offers several advantages, including reduced operation time, easier access to the kidney, lower risk of complications, and the possibility for simultaneous antegrade and retrograde approaches to the stones. It can also be safer for patients with certain medical conditions that make lying prone (face down) for extended periods challenging.

How do I know if I’m a candidate for supine PCNL?

Candidates for supine PCNL typically have large or complex kidney stones that cannot be effectively treated with less invasive methods. We will consider your overall health, the size and location of your kidney stones, and your previous treatments when determining if supine PCNL is the best option for you.

What can I expect in terms of recovery and pain management?

Recovery from supine PCNL involves managing pain with medications, which can include oral painkillers and sometimes medications to prevent infection. Most patients notice a significant improvement in symptoms within a few days and can return to normal activities within 2-3 weeks, avoiding heavy lifting or strenuous activities for a period recommended by the surgeon.

Are there any dietary or lifestyle changes I should make after the procedure?

After supine PCNL, increasing fluid intake to help flush the urinary system and avoid new stone formation is important. Your doctor may also recommend dietary changes or medications to prevent future kidney stones based on the type of stones you had.

How effective is supine PCNL in completely removing kidney stones?

Supine PCNL is highly effective in removing large and complex kidney stones, with high success rates for complete stone removal in a single procedure. The likelihood of needing additional procedures depends on the initial stone size and complexity.

What are the long-term outcomes after supine PCNL?

Long-term outcomes are generally excellent, with most patients experiencing significant relief from symptoms and a decreased likelihood of recurrent kidney stones with proper management and lifestyle adjustments. Regular follow-up care is crucial to monitor for new stone formation and ensure kidney health.