Renal Function Following Nephron Sparing Procedures: Simply a Matter of Volume?

Partial nephrectomy (PN) is the current standard of care for the management of small renal masses (SRM), providing comparable oncologic control with improved renal functional outcomes. Additionally, new technologies such as thermal ablation provide attractive alternatives to traditional extirpative surgery. The obvious benefit of these nephron sparing procedures (NSPs) is to the preservation of renal parenchymal volume (RPV), but the factors that influence postoperative renal function are complex and inter-related, and include non-modifiable factors such as baseline renal function and tumor size, complexity, and location as well as potentially modifiable factors such as ischemia time, ischemia type, and RPV preservation. Our review presents the most recent evidence analyzing the relationship between the modifiable factors in PN and renal outcomes, with a focus on RPV preservation. Furthermore, novel surgical techniques, imaging modalities, and NSPs are discussed, evaluating their efficacy in maximizing functional nephron mass and improving long-term renal outcomes.