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Nephron Sparing Surgery in Renal Tumors : A Case Report A 69 yrs old male presented to our OPD with h/o left sided varicocele. A known case of Diabetes, hypertension and bilateral medical renal disease, he underwent MRI abdomen which revealed a large lower pole lesion in left kidney with no renal vein or IVC thrombus. DTPA Scan revealed a 61% function in the affected kidney. Due to his bilateral medical renal disease and poorly functioning contra lateral kidney, he was planned for Nephron Sparing Surgery / partial nephrectomy (L) and DJ Stenting under cold ischaemia. Post op patient initially showed a rise in creatinine levels which gradually settled down to pre operative levels. Before we go into the discussion of partial nephrectomy or nephron sparing surgery (NSS) in RCC, I would like to emphasize on the presenting complaint. Varicocele in the left side is one of the presentation of Left sided kidney mass, which occurs due to the drainage of the gonadal vein into the renal vein on the left side and generally indicates tumor thrombus in the venous system renal/ IVC, however in this case it was because of compression of left gonadal vein by the renal mass. Renal tumors comprise approximately 3.8% of all new cancers with median age at diagnosis of 64 yrs. It is the third most common urological malignancy. The rate of RCC has increased by 1.6% per year for last 10 yrs, the reason of which is unknown. Majority of them are renal cell carcinomas and 80% of them are clear cell variety. Smoking and obesity are high risk factors of RCC. Some genetic diseases are also associated with RCC, like Von Hippel Lindau (VHL) disease. At presentation 25% are locally advanced. More often patient presents with metastatic disease (20%) . Only a few patients present with Virchows Triad - the 'too late triad' ( of hematuria, abdominal pain and flank mass). A CT Scan or MRI of the whole abdomen including pelvis clinches the diagnosis. A NEEDLE BIOPSY IS NOT NE

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