The outcome for patients with renal cell carcinoma has been dramatically changed by the refinement and widespread use of modern diagnostic tools. Concern about the unpredictable behaviour of renal cell carcinoma has been put aside, giving a new drive to research in all fields of this disease. Incidentally found tumours (> 50%) can frequently be treated by nephron-sparing surgery. This type of surgery is becoming more and more accepted and problems such as multifocality and the risk of local recurrence are now well documented. Improvement in surgical technique will make this approach valuable and safe.