Between August 1991 and June 1994, endoureterotomy was performed in nine patients for total ureteral occlusion. Four of these patients had an associated ureterovaginal fistula. The total ureteral occlusions were iatrogenic in eight patients and the result of trauma in one. The prone split leg position was used to facilitate simultaneous antegrade and retrograde ureteroscopy in all nine patients. The "cut-to-the-light" technique was utilized in six patients and a new technique employing a fascial incising needle was used in five patients. Five patients developed ureteral strictures within 5 months of the primary procedure that were corrected endoscopically. With a mean follow-up of 22 months, all nine patients have a successful outcome. Endoscopic management of difficult urteral disease such as total urteral occlusion and ureterovaginal fistula is a useful alternative to open surgery.