A 35-year-old man is found to have a left renal mass measuring 2.8 cm on CT. The lesion is entirely exophytic, clearly separated from the collecting system, and has a RENAL nephrometry score of 4 (low complexity). His contralateral kidney is normal. The preferred management per EAU 2024 guidelines for this small renal mass is:

• A Radical nephrectomy
• B Active surveillance with serial imaging
• C Immediate ablation (cryotherapy or RFA)
• D Partial nephrectomy (nephron-sparing surgery) ✓

Explanation

For a clinical T1a small renal mass (< 4 cm) with low nephron complexity score and normal contralateral kidney in a young patient, partial nephrectomy is the gold-standard treatment preserving renal function while achieving oncological equivalence to radical nephrectomy. Radical nephrectomy unnecessarily sacrifices renal parenchyma in a young patient. Active surveillance is acceptable for elderly/comorbid patients or incidental indolent-appearing lesions. Ablation is preferred in those unfit for surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.