Purpose: To assess the long-term outcome of early endoscopic realignment (EER) of complete posterior urethral disruption. Patients and Methods: The study included 11 consecutive patients with complete posterior urethral disruption secondary to a road accident (n? =? 9) or a falling impact (n? =? 2). EER was performed using a simultaneous endoscopic transvesical and transurethral approach under fluoroscopic guidance. An 18F Foley urethral catheter was left for 4 weeks. All patients were evaluated postoperatively for incontinence, erectile dysfunction, and urethral strictures. Results: The patients' mean age was 32 years (range 20-62 y). The mean duration of the realignment procedure was 40 minutes (range 30-60? min), and it was performed within an average of 48 hours (range 3-72? h) from hospitalization. Efficient erection was maintained in five (45%) patients, and incontinence did not develop in any patient. Five (45%) patients in whom urethral strictures developed were treated initially by endoscopic urethrotomy (EU), which was successful in one patient. Three of the four in the EU failure group remained on periodic urethral dilation, refusing to undergo urethroplasty, and one patient with interposition of a pubic bone fragment underwent successful urethroplasty. There were no other complications during a mean follow-up of 4.3 years (range 2-7 y). Conclusions: EER is a valuable alternative to long-term suprapubic drainage and delayed urethroplasty. Realignment failure did not interfere with the results of open urethroplasty. A further search for prognostic factors should improve the selection of patients for the early or the delayed approach.