Small renal masses (SRMs), which are tumors less than 4 cm in diameter, are increasingly discovered incidentally due to the rise in diagnostic imaging. Although many of these masses are benign, managing SRMs remains challenging. Active surveillance (AS) offers a viable alternative to surgery, particularly for patients with high surgical risks or limited life expectancy. AS, validated by various studies, involves close monitoring with regular imaging, enabling delayed surgical intervention if the tumor shows signs of progression. However, the adoption of AS is hindered by the absence of standardized protocols and the growing availability of minimally invasive surgical options.