There are hundreds of full-scale UASB reactors in operation in various parts of the tropical world, notably in India and Latin America, Brazil being the holder of the largest park of anaerobic reactors for sewage treatment in the world. Despite the recognized advantages of UASB reactors, there are problems that have prevented their maximum operational performance. Neglecting the existence and delaying the solution of these challenges can jeopardize the important advances made to date, impacting the future of anaerobic technology in Brazil and in other countries. This work aims to evaluate the operational performance of five full-scale UASB reactors in Brazil, taking into account a monitoring period ranging between two and six years. The main observed design, construction, and operational constraints are discussed. Some outlooks for important upcoming developments are also provided, considering that most of the observed drawbacks can be tackled without significant increases on reactor costs.