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

Step 1: Define the clinical problem.
A small (4 cm) exophytic renal mass at the lower pole in a patient with a SINGLE functioning kidney. A 4 cm mass is a clinical T1a renal cell carcinoma until proven otherwise.

Step 2: Apply nephron-sparing principle.
Because there is only one kidney, removing the whole kidney (radical nephrectomy) would render the patient anephric and dialysis-dependent. Nephron-sparing surgery is the imperative whenever preserving renal function is critical, such as a solitary kidney, bilateral tumours or pre-existing renal impairment.

Step 3: Confirm feasibility.
A 4 cm exophytic, lower-pole tumour is highly amenable to partial nephrectomy, which gives oncologic outcomes equivalent to radical surgery for T1a tumours while preserving function.

Step 4: Rule out other options.
Radical nephrectomy with dialysis or with transplant is excessive and unnecessary when the tumour can be excised with nephron preservation. Observation is inappropriate for a likely malignant solid mass in a young patient.

Conclusion: Partial nephrectomy is the best option, consistent with the printed key.