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As the vast majority of prior studies assessing the impact of ischemia, this series included patients with a normal contralateral kidney. It should be noted that, in this case, the effect on serum creatinine is blunted and, therefore, the effect on total GFR is minimized, although there might be a significant reduction in the GFR of the operated kidney. Renal reserve serves to protect the organism, maintaining a near normal GFR, and ischemic damage is potentially masked by the compensatory role of the normal contralateral kidney. Therefore, analysing renal function consequences of various technical scenarios during PN on a solitary kidney could be particularly informative. In a series of PN on solitary kidneys, Thompson et?al. concluded that whenever http://www.selleckchem.com/products/liproxstatin-1.html pedicle clamping https://en.wikipedia.org/wiki/Ketanserin was expected, warm ischemia should be completed within 20?min, and cold ischemia within 35?min. They also showed that warm ischemia patients are significantly more likely to develop acute renal failure in the postoperative period and chronic kidney disease during follow up compared with patients managed without hilar clamping.[9] Nguyen and Gill found a similar benefit in limiting warm ischemia to less than 20�C25?min when renal function decreases at a faster rate with additional minutes of ischemia.[10] This accumulated data should prompt us to preferentially choose PN with no clamping whenever technically feasible, especially in patients with a solitary kidney or preoperative renal function impairment. It is noteworthy that the absence of significant differences in eGFR decrease at 1?year in the present study could be due to the short ischemia time in this series, probably as a result of the small size of the tumors ( http://www.selleckchem.com/products/midostaurin-pkc412.html often necessary for allowing good hemostasis and obtaining a bloodless field, which is essential for successful tumor removal, with negative surgical margins and accurate surgical collecting system closure. Finally, it is obvious that a certain number of small renal tumors are indolent and not life-threatening. We should therefore integrate information, such as age, comorbidities, baseline renal function and technical difficulty of PN, in our decision algorithm. This is particularly true because increased alternative options exist for small renal tumor management, including active surveillance or ablative techniques, which are less deleterious options in regard to renal function. None declared. ""In patients with local recurrence without detectable metastasis after initial external beam radiation therapy, there are four options for treatment, namely salvage radical prostatectomy, salvage cryoablation, salvage brachytherapy, and salvage high-intensity focused ultrasound (HIFU).