**2. Protocol of SRM management**

It is estimated that 60% of all diagnosed renal cell carcinomas (**RCCs**) are SRMs that are discovered as incidentalomas on ultrasound and/or abdominal CT scans [4]. The current protocol in many urological renal centres, following the discovery of a SRM, is to offer the patient treatment options without a biopsy. Generally, unless contraindicated, these options include PN, RFA, or AS. This approach to treating a SRM is done without a clear histological diagnosis.

There should be a paradigm shift on how SRMs are approached. In some centres, RTBs are now performed upon the discovery of an incidentaloma. Here, patients are referred to an interventional radiologist who will then perform a RTB before their consultation with their urologist. Following the biopsy results from the pathologist, the urologist will meet the patient and offer better informed treatment options.
