Introduction: Germany’s 2025 hospital reform promotes outpatient care, yet ureterorenoscopy (URS) remains predominantly inpatient. This study compares outcomes of outpatient versus inpatient URS. Methods: This retrospective, dual-center study compared patients who underwent URS in either an inpatient (Regensburg) or outpatient (Landshut) setting. Surgical parameters, stone-free status, and postoperative complications (classified by Clavien-Dindo) were analyzed. Risk factors for complications were evaluated using chi-square testing. Results: Baseline characteristics were comparable between groups. Complication rates – particularly Clavien-Dindo grade II – were higher in the outpatient cohort. Residual stone rates, surgical time, and postoperative fever did not differ significantly. Residual stones (p < 0.001) and surgical time above the median (p = 0.003) were identified as significant risk factors for postoperative complications. Conclusion: Outpatient URS is a safe and effective alternative to inpatient treatment, with comparable stone-free rates, operative times, and postoperative fever incidence. The higher rate of minor complications in the outpatient setting likely reflects a more precautionary antibiotic management strategy rather than increased clinical severity. These findings support broader implementation of outpatient URS, while emphasizing the need for antibiotic stewardship and further prospective, multicenter investigations.