Purpose <p>To determine whether omitting routine indwelling catheterization after ureteroscopic lithotripsy reduces postoperative lower urinary tract symptoms and enhances patient comfort, without compromising safety.</p> Methods <p>In this prospective, multicenter, randomized controlled trial, 180 patients undergoing ureteroscopic lithotripsy from August 2024 to June 2025 at four centers were allocated to either the No-Catheter group (<i>n</i> = 91) or the Catheter group (<i>n</i> = 89). The primary outcome was the incidence of lower urinary tract symptoms (LUTS) evaluated by the Patient Perception of Intensity of Urgency Scale and the Visual Analog Scale for pain at 1&#xa0;h, 4&#xa0;h, 1&#xa0;day postoperatively. Secondary outcomes included complications (fever and urinary retention) and distressing memories assessed at a 1-month follow-up using the Subjective Units of Distress Scale.</p> Results <p>The No-Catheter group had significantly lower LUTS incidence at day 1 (9.9% vs. 24.7%, <i>p</i> = 0.012) and reduced urgency at 1&#xa0;h and 4&#xa0;h (<i>p</i> &lt; 0.05). Fewer No-Catheter patients reported distressing LUTS memories at 1 month (7.7% vs. 25.8%, <i>p</i> &lt; 0.001). Complication rates were comparable between groups (<i>p</i> &gt; 0.05).</p> Conclusion <p>Omitting routine indwelling catheterization after ureteroscopic lithotripsy appears to be a safe strategy that significantly reduces postoperative lower urinary tract symptoms and improves the patient experience. These findings support a change in clinical practice away from routine catheterization.</p>