OBJECTIVE Management of posterior urethral disruption due to pelvic trauma can be quite challenging and is the subject of ongoing controversy. This study presents an update of the University of California, San Francisco experience with delayed anastomotic posterior urethroplasty for management of these injuries. METHODS Since 1979 all patients undergoing posterior urethroplasty by a single surgeon at University of California, San Francisco and its affiliated hospitals have been entered prospectively into a patient registry. For this cohort descriptive statistics were calculated and recurrence was analyzed with the Kaplan-Meier method. Success was defined as no recurrence (by symptoms and/or retrograde urethrogram) or a mild recurrence managed successfully with a single internal urethrotomy. RESULTS A total of 134 male patients were analyzed with a mean of 32.9 and a median of 12 months followup. Mean patient age at surgery was 34.8 years. Of the patients 35% had undergone at least 1 prior procedure for stricture including prior urethroplasty in 16%. In addition, 22% required partial pubectomy and 4% a combined abdominal-perineal approach with total pubectomy. Of patients with a closed bladder neck on urethrography 34% vs 7% of those with an open bladder neck required pubectomy (p <0.001). Stricture length tended to be longer in pubectomy cases (mean 3.2 vs 2.1 cm by urethrography, p = 0.055). Of the patients 14% experienced recurrent stricture at a mean of 12 months, 42% of whom were treated successfully with a single urethrotomy. The overall success rate allowing 1 direct vision internal urethrotomy was 93%. CONCLUSIONS Anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and stricture disease even after multiple prior procedures.