Although safe and reliable, the use of renal tumour biopsy (RTB) for small renal masses (SRMs) in daily practise is uncommon. Given the high prevalence of benign tumours in individuals with renal masses less than 4 cm, some patients with benign tumours are recommended for surgery instead. The purpose of this study was to report RTB diagnosis rates, establish concordance with surgical pathology, and estimate the number of operations that might have been avoided. Researchers evaluated 255 patients who received RTB at our hospital between 2010 and 2019. 73 of them were left out of the analysis. The remaining 182 patients with unexplained SRMs of 4 cm received RTB guided by computed tomography. In 154/182 instances, biopsies proved to be diagnostic. Of the non-diagnostic biopsies, 11 were diagnostic when redone. When all indeterminate SRMs were RTB, active therapy was avoided in 50/182 individuals due to a benign diagnosis, whereas 9/182 patients continued monitoring following a consensus multidisciplinary decision. Overall, the diagnosis rate was 90.6 percent. All of the adverse events were Clavien-Dindo grade I and did not necessitate active treatment. The results of RTB histology and nuclear grading were substantially concordant with the final pathology. Male sex was the sole factor that contributed to diagnostic biopsy in univariate logistic regression analysis.RTB of SRMs should be conducted more often as part of a multidisciplinary decision-making process because it saves one of every three patients in our institution from needless surgical therapy.