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Abstract

Patients who present with bilateral synchronous sporadic renal tumors (BSSRT) remain a challenging population for management. The paradigm should remain nephron-sparing surgery whenever possible for the contralateral renal unit if renal cell carcinoma is confirmed on 1 side. Most patients who present with BSSRT will have renal cell carcinoma in 1 renal unit, 249 (83%) of 297 patients in our cohort. However, the challenge arises in patients who have histologic confirmation of a benign renal mass (oncocytoma) on 1 side. How should we manage the contralateral renal unit in these patients? In this circumstance, a renal mass biopsy with a fairly certain diagnosis of oncocytoma would provide reasonable evidence to continue active surveillance. Even without biopsy, our findings of a 71% concordance rate with oncocytoma in this population provide ample evidence to pursue active surveillance of selected patients within this population. Larger cohort studies with long-term follow-up are needed to further confirm the validity of this management paradigm. Editorial CommentUrologyVol. 78Issue 5PreviewThe consideration of tumor pathology in the management of bilateral renal masses is an important factor. If the determination of benign versus malignant histology could be made preoperatively, the treatment algorithms would be vastly different. In the absence of tumor markers, urologists currently rely heavily on personal experience and imaging to determine how to treat renal tumors, particularly multiple, simultaneous ones. In this article, the authors attempt to find radiographic clues to the histologic nature of renal tumors. Full-Text PDF