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Objective The aim of our study has been to evaluate our results in the treatment of urethral stenosis through several surgical approaches of urethroplasty: the one-stage procedure by direct end-to-end anastomosis, the free dorsal onlay graft urethroplasty using buccal mucosa, and the two-stage urethroplasty. Methods Between February 2009 and January 2012, 53 patients were enrolled and analyzed for different types of urethral reconstruction. Results The procedures included direct end-to-end anastomosis in 26 patients (49%), 18 (34%) underwent a two-stage urethroplasty (Johansen's), in 9 a free dorsal onlay buccal mucosa urethroplasty was performed. At a mean follow-up of 17 months, we had an overall success rate of 95%. When stratified on the basis of the procedure performed, in the direct end-to-end anastomosis 98% of patients had no evidence of recurrent stricture, 96% of success rate was reached in the onlay buccal mucosa urethroplasty, and 91% in the two-stage procedure. Conclusions In patients with urethral strictures, urethroplasty has to be preferred with respect to urethrotomy, which is the cause of a high percentage of recurrence, and holds the risk of compromising the success of further surgical procedures of urethroplasty. Differently, several techniques of urethroplasty offer a high percentage of success rate until 95%, as showed by our results.