Endosurgical management of ureteral strictures includes balloon dilation, cutting balloon (Acucise), and endoscopic incision with a cold knife, laser, or electrocautery. To date, there are no data regarding the acute tissue changes resulting from these interventions. Using the normal pig ureter, we evaluated each of the above modalities. The ureters were harvested 2 hours after dilation or incision. Histologic sections were graded for urothelial loss, inflammation, edema, and vascular injury. Balloon dilation resulted in minimal changes seen only in the lamina propria. No significant difference was noted in the amount of tissue injury produced by the cutting modalities. Incisions with the cutting balloon were performed with much less difficulty than those done endoscopically.