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Pulmonary metastasectomy has been established as a treatment option for select patients with metastatic disease. However, its role in urological malignancies remains underexplored. This study aimed to evaluate the clinical outcomes of pulmonary metastasectomy in patients with urological cancers, with a focus on renal cell carcinoma (RCC). We retrospectively reviewed 18 patients who underwent pulmonary resection for suspected metastases from urological malignancies at a single institution between 2014 and 2023. A subgroup analysis of 11 patients with RCC was conducted. The cohort included 13 patients with kidney cancer, four with testicular tumors, and one with prostate cancer. Pulmonary lesions were confirmed to be metastatic in 14 patients and inflammatory changes in four. The median disease-free interval was 25 months and the median overall survival after pulmonary resection was 113 months. In the RCC subgroup, the 10-year survival rate exceeded 50%, despite a 66.7% recurrence rate. No significant prognostic factors were identified, although favorable trends were observed for younger age, solitary metastases, and absence of vascular invasion. In urological malignancies, particularly renal cell carcinoma, pulmonary metastasectomy was associated with prolonged survival in carefully selected patients. Surgical resection may serve both therapeutic and diagnostic purposes, supporting its role within a multidisciplinary treatment strategy.