The incidence of renal cortical tumors (RCTs) has progressively risen over the last 30 years, believed to be largely attributable to the increasing use of abdominal imaging for unrelated conditions. Currently, over two-thirds of newly diagnosed renal masses are <4 cm, so-called small renal masses (SRMs). Because there is no curative medical therapy and because the natural history of these masses is not well understood, the primary treatment of SRMs has historically been prompt surgical excision. While curative extirpative surgery was traditionally accomplished by radical nephrectomy (RN), advances in surgical technique, as well as the recognition of the potentially deleterious renal functional and cardiovascular effects that may occur following surgically induced nephron loss prompted an interest in utilizing nephron-sparing techniques, particularly partial nephrectomy (PN). Prospective and retrospective studies have demonstrated that PN carries a lower risk of long-term renal dysfunction, and have demonstrated oncologic outcomes equivalent to RN. As such, elective PN is considered the preferred treatment for patients requiring intervention for cT1a and select cT1b renal masses. There is, however, some disagreement between prospective and retrospective data with regard to the overall survival benefits conferred by partial nephrectomy, leading some to question whether the increased mortality rates and cardiovascular disease attributable to decreased renal function from systemic and intrinsic renal diseases are truly applicable to decreased renal function purely from the surgical loss of nephrons. These considerations have led some to suggest that the pendulum in favor of PN “at all costs” may have swung too far and are reflected in the most recent American Urological Association (AUA) Guidelines for the Renal Masses and Localized Renal Cancer.