Orthotopic lower urinary tract reconstruction is the procedure of choice in appropriately selected men and women requiring cystectomy. Despite extensive experience with this technique, no consensus exists regarding which intestinal segment or reservoir configuration provides the best results. Consequently, various bowel segments and neobladder designs have been described. In 1988, Hautmann and colleagues initially described the ileal neobladder as a safe, reliable method of orthotopic urinary diversion. In this article, we describe our technique and experience with the modified ileal neobladder.