Decision regret after partial nephrectomy for benign small renal masses: The importance of preoperative counselling.

Objectives: This study aimed to evaluate decision regret following robot-assisted laparoscopic partial nephrectomy (RALPN) for benign small renal masses (SRMs) in patients who did not undergo preoperative renal mass biopsy (RMB) and to assess factors associated with regret and satisfaction with treatment decision-making. Patients and Methods: We conducted a mixed methods study combining retrospective clinical data with prospective patient-reported outcomes at a high-volume renal cancer centre. Patients who underwent RALPN for indeterminate SRMs ≤4 cm between January 2010 and July 2025 without preoperative RMB and were subsequently found to have benign histology were identified from a prospectively maintained renal cancer database. Participants completed a standardised questionnaire incorporating the validated Decision Regret Scale (DRS). Significant regret was defined as DRS ≥ 25. Decision regret was evaluated in relation to patients' recollection of counselling and perceived quality of preoperative information. Results: Of 1480 RALPN procedures performed during the study period, 167 patients met the eligibility criteria. Contact was established with 108 patients, of whom 104 agreed to participate and 58 completed the questionnaire. Median age was 66 years, and median tumour size was 30 mm. No Clavien-Dindo Grade ≥III complications occurred. Most patients recalled being informed that the lesion could be benign (79.3%). Discussion of RMB was recalled by 55.2% of respondents, whereas 29.3% reported no recollection of biopsy discussion. Overall decision regret was low, with a mean DRS of 13.8 (95% confidence interval [CI] 10.3-17.4), although 27.6% demonstrated clinically significant regret (DRS ≥ 25). Despite benign histology, 87.9% believed surgery had been the correct decision and only 29.3% would retrospectively have preferred RMB before surgery. Lower regret scores were observed in patients who recalled detailed RMB discussion and reported higher perceived quality of preoperative counselling. Conclusion: Most patients undergoing RALPN for benign small renal masses reported low decision regret despite ultimately benign pathology. Although over one-quarter of patients demonstrated clinically significant regret, the majority remained satisfied with their treatment decision and believed surgery had been the correct choice. Comprehensive counselling regarding diagnostic uncertainty and the potential role of renal mass biopsy may help minimise subsequent regret, reinforcing the importance of shared decision-making in contemporary small renal mass management.