Objectives: To compare the outcome of obliterative urethral stricture repaired by transperineal anastomotic urethroplasty and by an endoscopic realignment procedure in our institute. Materials and Methods: From 1996 to 2005, 20 cases from a single medical center in Taiwan were included in this retrospective study. Nineteen of them had obliterative urethral stricture as a complication after pelvic trauma, and all 19 patients received suprapubic urinary diversion; in 1 case, the stricture was idiopathic in origin, and he therefore had no suprapubic tube prior to any definite repair. Eleven cases subsequently received transperineal urethral repair, while the other 9 cases were treated endoscopically. Parameters and outcomes were obtained and were compared between the 2 surgical approaches. Results: Stricture length was significantly longer in the anastomotic urethroplasty group (2±1.8 vs. 1.1± 0.5cm, p=0.04). The mean delay time to definite surgical repair was longer in the open urethroplasty group (157 vs. 77 days, p=0.005). The postoperative hospital stay was also longer in the open surgery group (13.6±6.4 vs. 7.7±5.4 days, p=0.03). Primary failure, defined by stricture recurrence, was 54% (6/11) in the open surgical group and 55% (5/9) in the endoscopic group. The number of subsequent procedures required after the primary repair did not significantly differ (open: 1±1.2; endoscopic: 0.8±0.8, p=0.78). Stricture recurrence occurred within 3 months in 9 of 11 cases. Recurrent stricture after open surgery was generally short and could be easily managed by an endoscopic urethrotomy. No permanent failure or mortality was noted. Conclusions: The current study is the first report comparing an endoscopic realignment procedure and open anastomotic urethroplasty in treating obliterative urethral stricture disease in Taiwan. Both the transperineal anastomotic urethroplasty and endoscopic realignment procedure had a primary failure rate of about 55% in our series. The success rate after repairing obliterative urethral stricture in the current study was lower than what has been described by other authors regarding benign urethral stricture disease. Although it is difficult to give specific recommendations based on these data, we believe there is still great potential to improve outcomes in the future by careful selection of cases and refinement of surgical techniques.