Management of men with anterior urethral stricture disease is a relatively common issue faced by practicing urologists today. Anterior urethral strictures, which can be the result of congenital, idiopathic, iatrogenic or inflammatory causes, can affect patients of all ages and might present as some or all of the following disorders: difficulty with voiding, urinary tract infection, acute urinary retention and high bladder emptying pressures. A thorough understanding of the urethral anatomy and etiology of the stricture followed by effective treatment are crucial if successful outcomes for the patient are to be achieved. Historically, urologists viewed open repair as an option that should only be offered to patients who had failed to respond to repeated endoscopic treatments-the so-called reconstructive ladder. This dogma has, however, been scrutinized; urologists should be aware that this process may subject patients to repeated procedures with a low success rate, such as dilatation and internal urethrotomy, rather than one potentially curative operation, such as graft or flap urethroplasty.