Objective: There are currently no practical guidelines regarding recurrent or complex urethral strictures in Taiwan. Furthermore a specific urological reconstruction center focusing on urethroplasties in this area is currently unavailable. In this study we aim to share the experience of our institute according to an algorithm for this disease entity. Materials and methods: From December 2007 to October 2013, adult males with complex urethral strictures were enrolled. Six different surgical

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... iques were used for treatment. Clinical features and outcomes were analyzed through a retrospective chart review. Results: The mean age was 39 years, with a mean follow-up period of 42 months (range, 5e76 months). An average of three sessions of previous treatments was noted. The overall primary success, requiring no further intervention, was 46%. Permanent failure occurred in one patient (2.6%). The primary success for urethroplasty in distal, penile, bulbar, posterior urethra, and in stricture with hypospadias was 100%, 40%, 83%, 29%, and 60%, respectively. From the perspective of procedure type, anterior anastomotic urethroplasty (80%) and skin-based flaps (75%) resulted in the highest success rate. Following anterior or posterior buccal mucosal graft-augmented urethroplasties, 40% of patients received additional shortterm dilatations or urethrotomies. Conclusion: Complex urethral strictures can be managed by a variety of surgical techniques according to specific stricture locations. However, a careful postoperative follow-up for recurrences is mandatory, since~40% of patients undergoing buccal mucosal graft-augmented urethroplasties were expected to have additional procedures after the index urethroplasty.