The use of bowel segments in urinary diversions has been associated with an increased risk of neoplasia. This report describes three cases of intestinal adenocarcinoma following urinary diversion. In the first case, a 73-year-old woman developed moderately-differentiated colonic adenocarcinoma in her Indiana pouch 10.5 years after cystectomy. The second case involved a 77-year-old man with well-differentiated adenocarcinoma in his Indiana pouch 9 years after radical cystoprostatectomy and en bloc urethrectomy. The third case involved a 38-year-old man with moderately-differentiated adenocarcinoma arising in his ileal conduit 33 years after the creation of the conduit. These cases highlight the diagnostic signs of adenocarcinoma arising in urinary diversions and emphasize the importance of lifelong surveillance in these patients.