title: Incidental small renal mass: current management.
abstract: BACKGROUND
  To review options for minimally invasive urological surgery in the management of incidental small renal masses (<4 cm in size).
  
  
  METHODS
  The National Library of Medicine (PubMed) and MEDLINE databases were accessed to specifically search the available literature on minimally invasive urological surgery. Identified articles were then selected based on their contribution to the current evidence base.
  
  
  RESULTS
  There has been an influx of articles pertaining to the management of small renal masses. Treatment options continue to evolve and thus, the scope of articles was reduced to the last ten years. All data are observational statistics, and as such, are subject to selection bias and other problems inherent in non-randomized retrospective designs.
  
  
  CONCLUSIONS
  Selected cases of small renal masses can be observed with low risk of metastases, but this does not equate to zero risk. Nephron sparing surgery such as laparoscopic partial nephrectomy or open partial nephrectomy offers optimal oncological outcomes, nephron preservation and improved general prognosis. While there are no 'gold standards' in the management of the small renal mass, laparoscopic partial nephrectomy has demonstrated improving outcomes and minimal complications in the hands of an experienced surgeon. The challenge will be to encourage adoption of this technique, to ensure proficiency, but also be cognisant of the potential risks for lower volume surgeons. The role of ablative procedures is limited to the poor surgical candidate, and as an alternative to the technically difficult laparoscopic procedure. Until long-term data is available, this position is unlikely to change.
authors.affiliation: Rural Clinical School, University of New South Wales, Australia.
authors.forename: Sunny
authors.initials: S
authors.lastname: Nalavenkata
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Jarvis
authors.forename: Prem
authors.initials: P
authors.lastname: Rashid
mesh_terms: D001707:Biopsy, Needle; D017115:Catheter Ablation / Q000379:methods / Q000639:trends; D005260:Female; D005544:Forecasting; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods / Q000639:trends; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000592:standards / Q000639:trends*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000592:standards / Q000639:trends*; D009517:New South Wales; D018579:Patient Selection; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden