European Urology

Editorials

There is an increasing incidence of renal cell carcinoma (RCC). Apart from the real increase, more than half of the RCCs today are diagnosed incidentally during an imaging investigation for nonurologic symptoms. This development caused many RCCs to be detected when they were smaller than 4–5 cm. Another observation is that almost one fourth of these incidentally detected masses are benign in nature.

Organ- and function-sparing approaches are very common today in the management of solid tumors. Preserving the renal function has always been a major priority for the urologic surgeons. Once shown to be safe and oncologically effective in retrospective series, nephron-sparing surgery (NSS) is now the standard of care in small, exophytic solid renal masses [1], and [2].

Even selected RCCs either centrally located or larger than 4 cm can be safely treated by NSS, providing long-term cancer control [3]. Herr [4] recently published an excellent review on the history of partial nephrectomy for RCC in which he cites the paper published 30 years ago by Dr Puigvert and reprinted in this issue of European Urology [5].

Technically speaking, Gustav Simon [6] was the first surgeon to perform (1870) and publish the first case of partial nephrectomy. However, Vincenz Czerny [4] is credited as the first surgeon to perform partial nephrectomy for renal tumor (angiosarcoma) in 1887. It was a courageous operation in those days when antiseptic surgery was not common. Vermooten [7] published the first series in 1950.

In his landmark study, Puigvert reported on performing partial nephrectomy in 21 of 575 patients with renal tumors. He stressed the importance of this operation in “well-limited” tumors as well as in the obligatory cases. Most of his cases were cystic tumors. He particularly outlined the importance that this operation is not suitable for urothelial cancer. He depicted some cases with radiologic examples and claimed a long-term survival with this type of procedure that was comparable with total nephrectomy. His main aim was to preserve renal function, which is still our aim today.

There are no boundaries to human imagination and innovation. The dreams of the past are the realities of today. The hero urologists of the past had been pioneers in medicine and life sciences. Imagine the invention of the cystoscope and treatment of prostate and bladder tumors. Remember all the attempts at kidney preservation, dialysis, and kidney transplantation. Look at the developments in our understanding of the molecular pathways in renal cancer and their implications on our practice. We all face this challenge; progress, and advance in our discipline. Research—be it basic, translational, or clinical—is the only way to move our specialty forward. The leaders of today have to support all types of research in our field, and seek those young men and women with bright minds and vision. I do not have the slightest doubt that the future members of our discipline will continue to be the leaders of our profession. The shared information of today will benefit many patients in the future.