Orthotopic neobladder has become the standard of care in the selected patient undergoing cystectomy for invasive bladder cancer. It satisfies all the criteria for an ideal urinary alternative without compromising the delivery of needed adjuvant therapy or treatment for recurrent disease. Forty patients underwent orthotopic neobladder formation. Five patients received full course adjuvant chemotherapy without change in the dose, schedule, type or timing of the protocol because of the neobladder. Three patients received full dose XRT to recurrent pelvic masses without compromising the neobladder function. Systemic chemotherapy was given to 8 patients as per standard protocol for metastatic disease with no changes due to the presence of the neobladder.