Percutaneous endoscopic treatment of the kidney retains a place in the treatment of renal stones (
percutaneous nephrolithotomy--PCNL) and ureteropelvic junction abnormalities (endopyeloplasty). It requires anaesthesia ensuring surgical comfort and safety for the patients despite changes in position and the prolonged ventral supine position. The operation carries certain iatrogenic risks related to caliceal irrigation in patients with more or less documented episodes of
infection and carries risks of haemorrhage and effraction of adjacent organs. 282 patients treated by PCNL between 1984 and 1991 were reviewed in order to define the respective indications for general anaesthesia and peridural anaesthesia and to determine the modalities, to evaluate the risk and severity of absorption of irrigation fluid and to assess the risk of
infection by defining the indications for prophylactic
antibiotics. General anaesthesia, using
etomidate and
propofol via an
infusion pump, ensures surgical comfort, anaesthetic safety and better control of
intraoperative complications. The renewed interest in this technique must be counterbalanced by the growing incidence of
anaphylactic reactions related to anaesthetic drugs. Operations lasting more than 2 hours, raised intracaliceal pressure, the initially exclusive use of
glycine for irrigation induce haemodilution complications, possibly aggravated by
glycine intoxication. Repeated surgery is preferable with the use of an Amplatz tube as often as possible and physiological saline, except when required by the operation. Patients with a history of
urinary tract infection or infected stones should receive prolonged and effective
antibiotics before, during and after the operation. Prophylactic
antibiotics are reserved for those patients with no history of
infection. These principles equally apply to
percutaneous nephrolithotomy and endopyeloplasty.