Most solid renal masses are presumed to represent renal cell carcinoma. Percutaneous biopsies of renal cell carcinoma have been discouraged because traditionally it was believed that surgery provides tissue diagnosis, staging, and grading as well as definitive treatment. Percutaneous renal mass biopsy was shown to be inaccurate and finally, beside rare complications such as bleeding and pneumothorax, biopsy may facilitate tumor seeding along the needle tract. In recent years, due to an increased use of cross-sectional imaging, more renal masses are being detected. The size of renal masses in contemporary series is smaller than in historical cohorts. On the basis of our findings and according to reports by others, approximately 20% of small renal masses are benign. We reviewed the indications, techniques, success rates, accuracy and complications of percutaneous biopsy of solid renal masses in adults in order to debate whether it is currently indicated to reconsider the role of renal mass biopsy in the diagnostic flowchart of small renal masses workup. Such a modification, if proven to be justified, may spare a substantial number of patients the risk and morbidity of nephrectomy or partial nephrectomy.