Objective    To investigate the feasibility and safety of percutaneous nephrolithotomy (PCNL) by 2 stages on selected patients (age≥60

insufficiency of cardiorespiratory function and/or upper urinary infection) under assisted local anaesthesia.     Methods    Between January 2006 and March 2008

12 patients (7 men and 5 women with a mean age of 70.2) with unilateral large renal stone were enrolled in this retrospective study. The mean stone diameter was 3.4 cm (ranging from 2.0 to 4.5 cm). Pulmonary function and blood gas analysis were tested in all patients preoperatively. Abnormal pulmonary function tests were observed in all 12 patients. Seven cases were found to have hypertensive heart disease

3 patients with cardiac insufficiency

4 cases with diabetes and 6 patients having upper urinary infection. All patients had an anesthesia risk with American Society of Anesthesiologists (ASA) grade 3 or above. First operation of percutaneous nephrostomy was performed under local anaesthesia (lignocaine) guided by ultrasound in lateral position or prone position. A 12-F nephrostomy tube was left in place for 5 to 7 d

and then the secondary operation was carried out in lateral position. After having infiltrated the tract and the renal parenchyma with lignocaine

dilatation of the nephrostomy tract was performed. PCNL was done using a 8.5-F rigid ureteroscope and holmium laser lithotripter. Pain scores were measured using 10-cm linear visual analogue scale (VAS) after the completion of both procedures.     Results    The mean operative time of first stage was 21 min (15 to 25 min)

and that of the second stage was 39 min (21 to 62 min). No blood transfusion was needed to any patient. The mean VAS score was 39 mm (21 to 62 mm) for the first stage

while 35 mm (15 to 64 mm) in the second stage. The whole procedure was well tolerated without any need for general anaesthesia. Fever (>38.5 ℃) was noted in one patient

who was treated with intravenous antibiotics. Only one patients had residual stone fragments (diameter 0.4 cm). No pulmonary infection and cardiac complications were noted in these patients. After  6 to 18 months’ follow-up

no stone was recurred and no upper urinary tract infection was found.     Conclusion    Our findings suggest that the two-stage PCNL is effective and safe for the selected aged patients with insufficiency of cardiorespiratory function and/or upper urinary infection. Local anaesthesia has no effect on the efficacy and safety of PCNL.