Objectives: To describe the current role of first-stage urethroplasty and its success as a management option in patients with complex anterior urethral stricture disease. Methods: We reviewed our urethral stricture database to identify patients managed with a staged urethral reconstruction or permanent first-stage urethroplasty. We noted patient age, etiology of stricture disease, location and length of stricture, location of neomeatus, indication for a staged approach, follow-up, and failure rate. Results: A total of 38 men with a median age of 53 years met the inclusion criteria. The etiology of stricture disease varied, most commonly prior hypospadias repair (n = 9 [24%]) and lichen sclerosis (n = 6 [16%]). Location of stricture disease varied throughout the anterior urethra. Median stricture length was 5 cm. First-stage urethroplasty was accomplished with a penile shaft neomeatus in 13 patients (34%) and a perineal neomeatus in 25 (66%). Median follow-up was 22 months. Postoperative urethral dilation was required in 7 patients (18%). No patient has required an indwelling urethral catheter, suprapubic cystostomy, or urinary diversion. Of 38 patients, 9 (24%) have undergone a second-stage urethroplasty. Conclusions: The first-stage urethroplasty produces unobstructed voiding with few complications in high-risk patients. Few patients elect to have a second-stage urethroplasty performed. This is an old but not obsolete concept. We have presented modifications in technique to optimize success.