Continuous improvements in radiological imaging techniques have enabled an earlier diagnosis of incidental renal tumors. The share of small renal tumors (<or=4 cm, T1a) amongst the incidentally detected renal masses is reported to be as high as 60%. Fortunately, the classic clinical triad of pain, hematuria, and a palpable flank mass is nowadays the exception of clinical presentation. Concerns regarding development of chronic renal failure after radical nephrectomy have resulted in an increasing use and steady improvement of organ-sparing surgical techniques for patients with small unilateral renal tumors in the presence of a normal contralateral kidney (elective indication). Nephron-sparing surgery has become the gold standard for treating these small tumors. Newer long-term oncological results have demonstrated that carefully selected patients with unilateral renal tumors >4 cm can also be treated with nephron-sparing surgery. We report in this article our long-term oncological results of nephron-sparing surgery in patients with an elective indication.