{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T23:23:33Z","timestamp":1784935413968,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the clinical benefit and cost\u2010effectiveness of a renal biopsy (RB)\u2010all strategy for patients with a renal mass, as in renal cancer the indication for upfront surgery (SUR) without previous RB invariably results in the overtreatment of patients with benign histology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>A total of 1729 patients with clinical (c)T1\u20132\u2009cM0 renal mass treated with SUR were included. To simulate a randomised clinical trial comparing patients who underwent SUR vs RB and subsequent treatment, a random binary variable assigned patients to Arm a\u2010SUR and Arm b\u2010RB. In Arm a\u2010SUR, patients are all treated with SUR; postoperative complications and costs are those recorded after surgery. In Arm b\u2010RB, we have assumed an 8\u201320% uncertain RB histology rate and a 0.07% RB\u2010related complication rate to build our simulation model. Patients are selected for RB and subsequently for surgery in case of malignant or uncertain RB histology; complications are those recorded after surgery in case of malignant or uncertain RB histology, but 0% in case of benign histology. The outcomes of the study were the rate of SUR avoided, the rate of Clavien\u2013Dindo Grade specific complications avoided, and the net difference in per\u2010patient cost in Arm b\u2010RB relative to Arm a\u2010SUR. In all, 10\u2009000 individual iterations of the simulation model were performed and among all iterations, the median and 95% confidence intervals were computed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>If a RB\u2010all strategy is implemented, the expected rate of SUR avoided is 6.7%. The rate of overall, Clavien\u2013Dindo Grade &gt;II, and Clavien\u2013Dindo Grade &gt;III complications avoided is 3.0%, 2.5%, and 0.5%, respectively, and the average net difference in per\u2010patient cost was \u2212$840 (US dollars).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The non\u2010selective use of RB in patients with a renal mass avoids a significant number of SUR, a marginal but existing number of complications, and is associated with decreased healthcare expenditures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bju.16885","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:00:38Z","timestamp":1756281638000},"page":"930-936","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biopsy\u2010all strategy in patients with a renal mass: simulation of a randomised controlled 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