Purpose <p>Despite modern advances in urethroplasty, little consensus exists on defining treatment success. The absence of reintervention was the main benchmark. However, recent efforts incorporate anatomical, functional and patient-reported criteria. Our aim is to evaluate urethroplasty outcomes using these four criteria, and to assess the progression of asymptomatic anatomical recurrences to predict the need for future treatments.</p> Methods <p>An ambispective study was conducted on patients &gt; 18 years undergoing anterior urethroplasty between 2020 and 2023. Minimum follow-up of 2 years. Techniques included anastomotic and augmentation urethroplasties. Follow-up performing urine culture, uroflowmetry, self-administered questionnaires, and endoscopic/radiological imaging. Success was defined as: anatomical (passage of a 17Ch cystoscope or normal urethrogram), functional (Qmax &gt; 10 mL/s), asymptomatic (no urinary symptoms or infections), no need for further treatments, and overall success.</p> Results <p>138 patients were followed for a mean of 35 months (IQR = 24.4–63.8). Success rates were: anatomical 68.8%, functional 71.7%, asymptomatic and retreatment-free 79%, and overall success 63.8%. USS-PROM and quality of life scores improved significantly with high satisfaction levels and maintained IIEF-5 scores. Among the 43 patients with anatomical recurrences, 22 were asymptomatic (51.2%) when re-stricture was identified. After 35 months, 16 out of 22 (72.7%) remained symptom-free. All symptomatic progressions, leading to further interventions, developed during the first 18 months.</p> Conclusions <p>Anatomical and functional criteria result in lower success rates than symptoms-based or retreatment definitions. Most patients with asymptomatic anatomical strictures who do not develop symptoms in the first 18 months remain stable and do not require secondary treatments.</p>