Patients with neurogenic bladder (NGB) from spinal cord injury (SCI) are at increased risk for developing bladder cancer. The choice of urinary diversion in patients with NGB and bladder cancer remains controversial and is dependent on patient preference, manual dexterity, social support, and renal function. We describe the outcome of a man with NGB from SCI who developed bladder cancer, underwent cystectomy with creation of an orthotopic neobladder, and now voids by Valsalva. To our knowledge, we report the first successful use of an orthotopic neobladder in a patient with NGB after radical cystectomy for bladder cancer.