We evaluated the effectiveness and safety of ureteroscopic pneumatic lithotripsy (URS-PL) for the treatment of urological calculi under sacral block anesthesia. URS-PL was performed with a semirigid ureteroscope under sacral block anesthesia in 90 patients between January 2006 and April 2010. Calculi were located in the middle ureter in 20 patients, the distal ureter in 48 patients, the bladder in 20 patients, and the urethra in 2 patients. We carried out URS-PL in all patients under sacral block anesthesia with 20 ml 2% lidocaine. An objective pain score scale was used to assess patient pain and anxiety. Adverse events were recorded. The results showed the overall stone-free rate was 97.8%, the rate being 100% for calculi in the bladder, urethral and distal ureter, 90.0% for calculi in the midureter. The mean operative time was 25.2 min (range 10-60 min). We had perfect pain control in the majority of the patients. Patients' acceptance was very high. Only two patient required conversion to epidural block anesthesia. No anesthetic-related side effects occurred in all patients. These finding suggest that sacral block anesthesia is a safe and efficacious mend during URS-PL in urological calculi, especially those patients in the distal ureter and calculi <1 cm.