The upflow anaerobic sludge blanket (UASB) reactor has been recognized as an important wastewater treatment technology among anaerobic treatment methods. The objective of this study was to perform literature review on the treatment of domestic sewage using the UASB reactor as the core component and identifying future areas of research. The merits of anaerobic and aerobic bioreactors are highlighted and other sewage treatment technologies are compared with UASB on the basis of performance, resource recovery potential, and cost. The comparison supports UASB as a suitable option on the basis of performance, green energy generation, minimal space requirement, and low capital, operation, and maintenance costs. The main process parameters such as temperature, hydraulic retention time (HRT), organic loading rate (OLR), pH, granulation, and mixing and their effects on the performance of UASB reactor and hydrogen production are presented for achieving optimal results. Feasible posttreatment steps are also identified for effective discharge and/or reuse of treated water.