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Image-guided percutaneous renal biopsy is safe and accurate in sampling the lesion and coming to a final histopathological diagnosis. Image-guided renal mass biopsy is useful for avoiding unnecessary surgery for benign masses and in the diagnosis of renal metastases, lymphoma, differentiation of centrally located renal cell carcinoma from renal cell carcinoma, and complex cystic renal lesions. The renal biopsy can be performed with either CT or US guidance, although the majority of the current literature is based on CT-guided procedures. Although radiofrequency ablation has been used most often for liver tumors, its use for renal masses is relatively recent and has shown promising clinical results. Long-term follow-up radiofrequency ablation results for renal masses are still being performed to define the position of this treatment in the management of renal neoplasm. The ideal lesion for radiofrequency ablation in the kidney is single, peripherally located and less than 3 cm diameter renal mass. Radiofrequency ablation of a renal mass is often useful as an alternative to nephron-sparing surgery in poor surgical risk patients and in patients with a solitary kidney. As the frequency of detection of renal masses increases and the utility of percutaneous biopsy and radiofrequency ablation are better defined in the literature, we are likely to see these procedures become more frequent in patient management.

Transarterial embolization is an accepted therapeutic option in palliating symptoms related to renal cancer with very high success rate and low complication rate. Proper selection of both embolic material and the catheterization approach are essential to the success of the procedure. The role of renal TAE in disease control and survival improvement seems promising. Further studies are needed to determine whether TAE improves survival in patients with disseminated disease or localized tumor. The value of TAE in patients with bone metastases has been well demonstrated to reduce pain or, if performed preoperatively, to decrease blood loss and transfusion requirements during surgery.

Nephron-sparing surgery has demonstrated satisfactory cancer control and patient satisfaction. Long-term functional advantages are gained by the maximal preservation of normal renal parenchyma. Multiphasic contrast-enhanced CT in combination with 3D volume-rendering CT imaging has become established as the essential imaging modality for preoperative evaluation of NSS, providing sufficient evidence of sensitivity and specificity of RCC, costeffectiveness, and ready accessibility. By having a better understanding of the indications, procedures, complications, and factors affecting patient outcome, radiologists can provide urologists with essential information for the preoperative planning of NSS.

Laparoscopic partial nephrectomy is emerging as an attractive, minimally invasive nephron-sparing option for the management of select renal lesions. It is associated with less need for postoperative analgesia, earlier hospital discharge, and more rapid convalescence. Experience with LPN continues to grow. The technique is evolving and issues of hemostasis and renal ischemia are being further addressed in the laboratory. It should be performed by surgeons with considerable laparoscopic expertise at centers where there is frequent interaction between open and laparoscopic surgeons.