We present 33 patients with complete prostatomembranous urethral disruptions: 20 were managed by immediate realignment, while 13 were managed by initial cystotomy and delayed urethroplasty. Techniques for immediate realignment are described. Immediate realignment of complete prostatomembranous disruptions resulted in an overall potency rate of 80% compared to only 50% in patients who underwent delayed repair. In addition, there was an increased need for a secondary operation when the repair was delayed. Continence rates were excellent and similar in both groups. Immediate urethral realignment as described results in impotence and incontinence rates that are comparable to or better than delayed repair techniques without the need for multiple surgical procedures.