The management of traumatic urethral strictures remains a challenge for urologists. Intercourse-related trauma and penetrating injuries are infrequent and involve the penile and bulbar urethral segments. Posterior urethral injuries due to pelvic fractures are more common and affect the proximal bulbar urethra and the posterior urethra in males. Intercourse-related trauma and penetrating injuries are infrequent and involve the penile and bulbar urethral segments. Female urethral involvement is far less frequent, and usually caused by direct contusion, laceration or fractured bone fragments. Immediate suprapubic urinary diversion is the first urologic emergency treatment. In most cases with posterior urethral distraction injuries, the existing defect between the urethral ends is small, and the ideal treatment is delayed anastomotic urethroplasty achieving a high cure rate (90%). Cases with extensive strictures and long defects may require the use of different sequential maneuvers to achieve a tension-free anastomosis: urethral mobilization, separation of corpora cavernosa, inferior pubectomy and even supracrural re-routing. Early endoscopic realignment of posterior urethral injuries has gained acceptance during the last decades and can be tried in patients with short distraction defects but achieving a low cure rate (<30%). Generally, incontinence (2%) and impotence (40%) result from the injury itself and not the treatment.