We reviewed our experience with the pedicled island flap technique in severe urethral strictures, especially in regard of the long-term follow-up of functional parameters: micturition patterns and sexual behavior. Analysis of 59 consecutive cases treated with this approach has proven the value of this technique. The results of a questionnaire and the current clinical status showed that, of the 59 cases, 12 patients were subjectively dissatisfied with their micturition, independent of the results of functional voiding measurements, and 2 patients complained of impaired potency: 1 immediately after the original trauma, the other after the surgical repair. The most frequent reported micturition complaints were only minor: dribbling, nycturia and frequency, mostly already existing before the operation. The objective results, obtained postoperatively by uroflowmetry were good, but often did not correlate with the subjective results. The overall results are satisfactory. Only 3 patients replied to say that they regret having had the open operative procedure.