A 30 year old male presents with pain on the right flank and hematuria. A CECT abdomen reveals a large 8x8 cm sized solid mass in the right kidney and 3x3 cm solid mass occupying the upper pole of left kidney. The most appropriate surgical treatment for this pt is:

Ans. is 'c' i.e. Right radical nephrectomy and left partial nephrectomy This male pt. with flank pain, hematuria and demonstration of a solid renal mass is having renal cell carcinoma (in clinical practice any solid renal mass is considered RCC until proved otherwise)The standard treatment of RCC is radical nephrectomy, but if the tumor is bilateral or the pt is having only one kidney than a partial nephrectomy is performed.* Harrison writes - * "Partial nephrectomy may also be performed for pts with bilateral tumors accompanied by a radical nephrectomy on the opposite side"These partial nephrectomy (or Nephron sparing) procedures are found to be equally effective as radical nephrectomy, if the mean tumor size is less than 4 cms.Now a days the trend is to try a partial nephrectomy operation even in pts with normal opposite kidney.