Evaluation and management of solid and cystic renal masses

With the increasing detection of incidental renal lesions, the evaluation and management of solid and cystic renal masses are assuming greater importance in urological practice. A review of the techniques for evaluation and management is presented, with an emphasis on new and evolving procedures, along with recommendations for their selective use.

A MEDLINE computerized reference search and manual bibliographic review were performed to find pertinent peer reviewed articles published since 1985. Meeting abstracts were considered if they provided unique information.

The primary means of evaluating renal masses is radiography (mainly ultrasonography and computerized tomography), although minimally invasive techniques such as percutaneous biopsy and laparoscopy are useful in selected situations. Nephron sparing surgery, minimally invasive surgery, alternative energy sources and other new techniques are being increasingly applied to the management of solid and cystic renal masses.

Simple renal cysts can be defined ultrasonographically but more complicated masses require computerized tomography, other imaging modalities or rarely biopsy. Currently, minimally invasive techniques are commonly applied only to assist in the diagnosis of selected renal lesions and to treat benign simple cysts. The treatment of choice of solid renal masses remains open surgical radical nephrectomy and partial nephrectomy but alternative techniques will likely have a more significant role in the near future.