Question

A 40-year-old patient has a single kidney with an exophytic mass of 4 cm size at its lower pole. Which among the following is the best course of action?

• A. Partial nephrectomy
• B. Radical nephrectomy with dialysis
• C. Radical nephrectomy with immediate renal transplant
• D. Observation

Hint:

Only one kidney plus a small T1a tumour means preserve function.

Answer 1

The Correct Option is A

Picture the dilemma: the patient owns a single kidney, and that kidney now carries a 4 cm solid lump bulging out of the lower pole. A solid renal mass of this size is treated as renal cell carcinoma, so it cannot be ignored, yet the kidney must also be protected because it is the patient's only one.

This is exactly the setting where nephron-sparing surgery is mandatory. The classic mandatory indications for partial nephrectomy are a solitary kidney, tumours in both kidneys, and poor baseline renal function, all situations where taking the whole organ would force the patient onto dialysis. A 4 cm tumour that projects outward from the surface is technically straightforward to shell out while leaving the rest of the kidney intact, and for such small (T1a) cancers the cure rate matches that of complete kidney removal.

Removing the whole kidney and committing the patient to lifelong dialysis, or to a transplant with its immunosuppression burden, is needless overtreatment. Simply watching a probable cancer is also wrong. The correct, function-preserving and oncologically sound choice is to excise only the tumour.

\[\boxed{\text{Partial nephrectomy}}\]