Orthotopic ileal urinary bladder replacement is an established method after radical standard cystectomy for both genders. In 1986 Hautmann described for the first time the technique of bladder reconstruction using the ileum at the University of Ulm. The W shape of the ileum buffers the coordinated peristaltic waves. The detubularized orthotopic ileal reservoir has been used worldwide ever since because of its technical simplicity, its reduced risk, and its good functional results. The good results published in the literature for this technique were reported by larger centers. With regard to these results, we wondered in 1994 if our smaller department with fewer patients might also offer this technique for male and female patients who had undergone cystectomy. The question was if this method would produce the same results as in large series, provided that patients were adequately selected and surgery carefully performed. This would provide the evidence that the surgical technique is simple, reproducible, and has the same complication rates, such as mortality and morbidity, also for departments with less experience.