Minimally invasive incisional techniques have become an established part of the endourologist’s armamentarium for the treatment of a variety of congenital and acquired conditions. Improvements in equipment and technique have allowed these procedures to become a first-line option in properly selected patients for the treatment of various causes of upper and lower urinary tract obstruction. Despite lesser success rates compared to open and laparoscopic reconstructive approaches, shorter postoperative convalescence makes these procedures especially attractive to patients. This chapter will review the indications, technical aspects, equipment needs, and outcomes for incisional procedures used for the management of ureteropelvic junction obstruction and ureteral and urethral strictures.