Abstract
Radical nephrectomy is still widely held as being the most effective treatment for renal carcinoma. Such an aggressive approach is, however, inadvisable in patients with sole kidney, especially as no advantage has been shown in terms of survival compared to surgical procedures which spare the renal parenchyma and do not condemn the patient to extracorporeal dialysis or a transplant. Conservative surgery is therefore the treatment of choice in the case of bilateral carcinoma or sole functioning kidney. It allows complete removal of the tumour, helped by the actual characteristics of the same, while enough renal parenchyma si preserved to avoid uremia. Four clinical cases observed in the last 24 months are described and their surgical solutions are paradigmatic of the most frequently used therapeutic approach in obligatory conservative surgery of renal neoplasms. The cases consisted of 1 bilateral renal neoplasm, 2 neoplasms in sole kidney and 1 neoplasm in a patient with pluri-recurrent renal lithiasis. Post-operative course was regular in all cases and as of today there are no recurrences or metastases.
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