Management of Small Renal Masses

When we started to plan this special issue, we were under the thought that we are facing more and more cases of small renal masses in our daily work as urologists and pathologists. This common fact nowadays will probably increase in the near future as radiological studies are more frequently ordered and fortunately we face an increase in longevity, and also as people can get to detect their renal masses before they really arrive to the classic lumbar pain/haematuria/lumbo-abdominal mass symptoms. First of all, strict definition of small renal mass is lacking; most of the authors consider 4 cm as cutoff , imported from the classical one regarding partial surgery of the kidney and TNM classification; but we all know that these concepts are changing and probably will need to be taken into consideration. Been sure the increase in detection, we have to precise the different needs of radiological explorations to characterize a small renal mass; is sonography, CT, and MRI necessary for all patients? We are still lacking to differentiate from a standard radiological approach benign and malignant small renal masses. What is the role of percutaneous biopsies in these cases? These (and others) are questions that urologists do not answer uniformly. Economical issues are also important in a public medical system. When we move to therapeutic aspects, things are even more unresolved. There is an increasing number of small renal masses managed under a strict watchful waiting policy but this is not plausible for all cases. Limits of age and growth rate have been argued again for this approach and most of the times, at least in our country, people are not happy knowing they could harbor a renal cancer been just " observed ". Regarding active treatment, first radical nephrectomy and lastly open partial nephrectomy have been the gold standard approaches. In fact, main guidelines consider the second the treatment of choice for small renal masses nowadays , having shown the same oncological control compared to radical surgery. During the last decade, laparoscopic partial nephrectomy has emerged with comparable oncological results, adding better cosmetical and perioperative recovery data. The main drawback of laparoscopic partial nephrec-tomy is its difficulty, being just feasible in experienced centers with high volume of patients. In the last five years, different nonablative techniques have appeared to compete with partial (open or laparo-scopic) nephrectomy aiming to achieve same oncological control, testing percutaneous approach, reducing …