Orthotopic urinary diversion via the Kock ileal neobladder is the preferred form of bladder reconstruction in men and, now, in women undergoing cystectomy at the University of Southern California. Through June of 1993, 266 men were diverted in this fashion. There were 3 perioperative mortalities (1.1%); early complications occurred in 47 men (17.7%), whereas 35 (15.0%) experienced late complications. Approximately 85% of the men enjoy good or satisfactory continence day and night, with a large majority having a normal voiding pattern. Through May of 1993, 14 women were similarly diverted; 2 patients (14.2%) experienced early complications, whereas 1 patient (7.1%) had a late complication. The continence and voiding pattern appear to be even better in this small group of women as compared with the men. Orthotopic Kock continent urinary diversion yields an extraordinary functional result that can be accomplished with minimal complication and high patient satisfaction.