Small renal masses (SRMs) are a clinical challenge for the urologist, representing a heterogeneous population of lesions that can range from indolent disease to tumours with high malignant potential. With limited ability to evaluate the aggressiveness of kidney masses, combined with concerns regarding renal function preservation and overtreatment, clinicians are faced with the question of how best to treat a patient with an SRM. This specially commissioned Focus contains articles from experts in the field on the contemporary challenges of treating patients with an SRM, from the importance of preserving renal tissue and the controversial use of active surveillance to the promise of new focal therapies and robotic partial nephrectomy.
EDITORIAL
What next for the small renal mass?
Sarah Payton
doi:10.1038/nrurol.2013.85
Nature Reviews Urology 10, 245 (2013)
RESEARCH HIGHLIGHTS
Small renal masses: Indocyanine green cannot predict malignancy
Sarah Payton
doi:10.1038/nrurol.2013.51
Nature Reviews Urology 10, 250 (2013)
Small renal masses: Stable long-term renal function after partial nephrectomy in solitary kidney
Sarah Payton
doi:10.1038/nrurol.2013.66
Nature Reviews Urology 10, 254 (2013)
Small renal masses: Jury still out on robotic partial nephrectomy
Mina Razzak
doi:10.1038/nrurol.2013.65
Nature Reviews Urology 10, 250 (2013)
Small renal masses: Troubling nephrectomy trend data
Sarah Payton
doi:10.1038/nrurol.2013.57
Nature Reviews Urology 10, 251 (2013)
Small renal masses: Support for active surveillance in patients aged ≥75 years
Sarah Payton
doi:10.1038/nrurol.2013.82
Nature Reviews Urology 10, 253 (2013)
Small renal masses: Partial nephrectomy with thulium laser safe and effective
doi:10.1038/nrurol.2013.58
Nature Reviews Urology 10, 249 (2013)
Small renal masses: Robotic ultrasound probe OK for partial nephrectomy
doi:10.1038/nrurol.2013.73
Nature Reviews Urology 10, 252 (2013)
NEWS AND VIEWS
Small renal masses: The effect of illness uncertainty during active surveillance
Paul L. Crispen
doi:10.1038/nrurol.2013.63
Nature Reviews Urology 10, 255-256 (2013)
Small renal masses: A positive surgical margin does not affect survival
Jens J. Rassweiler & Ali S. Gözen
doi:10.1038/nrurol.2013.78
Nature Reviews Urology 10, 256-257 (2013)
Small renal masses: Time to standardize follow-up of low-stage renal cancer
Ashraf Almatar & Michael A. S. Jewett
doi:10.1038/nrurol.2013.87
Nature Reviews Urology 10, 257-259 (2013)
Small renal masses: The promise of thulium laser enucleation partial nephrectomy
Thomas J. Guzzo
doi:10.1038/nrurol.2013.88
Nature Reviews Urology 10, 259-260 (2013)
Small renal masses: Is LESS partial nephrectomy feasible for most urologists?
Yu-Kuan Lin & Jay D. Raman
doi:10.1038/nrurol.2013.54
Nature Reviews Urology 10, 260-261 (2013)
REVIEWS
Active surveillance of small renal masses
Marc C. Smaldone, Anthony T. Corcoran & Robert G. Uzzo
doi:10.1038/nrurol.2013.62
Nature Reviews Urology 10, 266-274 (2013)
Smaldone and colleagues discuss the efforts that have been made to delineate the malignant potential of small renal masses (SRMs) in the preoperative setting and describe the existing data on the natural history of SRMs under observation. They also discuss the rationale for current active surveillance protocols.
Partial nephrectomy—contemporary indications, techniques and outcomes
Scott Leslie, Alvin C. Goh & Inderbir S. Gill
doi:10.1038/nrurol.2013.69
Nature Reviews Urology 10, 275-283 (2013)
Partial nephrectomy remains the cornerstone of treatment for the otherwise healthy patient with a small renal mass and good life expectancy. Herein, the authors present an update on the contemporary status of partial nephrectomy, focusing on the evolving indications, technical advancements and current outcomes data.
Ablative therapies for small renal tumours
Arturo Castro Jr, Lawrence C. Jenkins, Nelson Salas, Gideon Lorber & Raymond J. Leveillee
doi:10.1038/nrurol.2013.68
Nature Reviews Urology 10, 284-291 (2013)
Ablative modalities, which use energy–tissue interactions to ablate tumours, have emerged as an intermediate treatment option between active surveillance and surgical resection. In this Review, the authors discuss the four main ablative modalities that have been used to treat small renal masses—cryoablation, radiofrequency ablation, microwave ablation and irreversible electroporation.
Oncological and renal medical importance of kidney-sparing surgery
Paul Russo
doi:10.1038/nrurol.2013.34
Nature Reviews Urology 10, 292-299 (2013)
Despite accumulating evidence that partial nephrectomy provides equivalent oncological outcomes to radical surgery while also preserving renal function and preventing the adverse cardiovascular effects of chronic kidney disease, the technique remains underused. In this Review, Russo discusses the evolution of the partial nephrectomy technique and the importance of kidney-sparing surgery for small renal masses.
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