Recently, some patients who had radical cystectomy and orthotopic ileal neobladder done in previous years returned to the hospital for review, and the patients were all in good condition with no evidence of tumor recurrence and good urination. In fact, I often received patients for review, but now I feel that I can write a little clinical experience after being in this field for so long. The two patients I did last week with total bladder and orthotopic bowel substitution for the bladder had bowel ventilation the day after surgery, with very little bleeding and no blood transfusion during the entire procedure, which was considered a very smooth operation. In retrospect it seems that laparoscopic total bladder resection has the unique advantage of being able to do fine dissection and accurate operation with TV magnification, really clear levels and less bleeding. We at Wuhan Union Hospital have accumulated more clinical experience as we are in the forefront in the number of cases of radical bladder resection and orthotopic neobladder in China. Some professors from large hospitals in China have come to the Union Hospital to observe the surgery and exchange techniques. We have also done more clinical summaries ourselves, such as whether we need to do systemic chemotherapy after radical resection? And so on. In conclusion, we conclude that the technique of radical resection of bladder cancer combined with small bowel replacement of new bladder achieves the patient’s desire to have complete removal of bladder without urinary diversion and ensures the basic quality of life. Bladder tumors, the vast majority of which are malignant, can be cured and never recur in most people as long as no distant metastases occur. There are several types of bladder tumors. If it is superficial uroepithelial carcinoma, minimally invasive treatment with electrodesiccation surgery can be considered, but the depth of resection must be sufficient, and the bladder must be closely monitored after surgery for any new tumors growing in other mucosal areas. In case of high grade tumors, or infiltrative tumors, radical total resection should be considered as a priority. For this type of tumor, clinical guidelines in the United States and Europe call for radical resection, otherwise it is prone to recurrence and metastasis. Radical resection should be considered for multiple tumors of the bladder, tumors in the triangular area of the bladder, superficial tumors that recur repeatedly, and tumors that invade the bladder neck and urethra, unless the patient is extremely weak and cannot tolerate the surgery. If the pathological type is adenocarcinoma of the bladder, squamous carcinoma or bladder sarcoma or the like, the recurrence rate and patient survival after surgery are much worse compared to uroepithelial (or metastatic epithelial) carcinoma. In radical surgery, there are more considerations for surgical operation, such as lymph node dissection should be done to close the lymph nodes and complete removal of iliac vessel lymph nodes. Anastomosis of the bowel is best done with pulpy muscle layer reinforced sutures to prevent bowel leakage, and urethral anastomosis should be done with attention to reducing tension and reducing the incidence of anastomotic leakage. Post-operative patient management is also important to maintain the usual drainage of the new bladder and to supplement nutrition to promote the healing of the new bladder as soon as possible. There are no words to describe how bad a patient feels when he or she has cancer. Once the diagnosis is made, it is like a bolt from the blue. The patient and the family will have many thoughts and doubts, and even consider re-planning and rearranging the whole rest of their lives, so the request to the surgeon can be more important than the mountain. Therefore, when dealing with patients, we have to do our part by explaining the severity of the disease, the possible prognosis of the disease, and the advantages and disadvantages of each treatment method. We also have to face the risks and be brave enough to do our best to save the patient’s life and not to take lightly or give up the patient’s precious chance of survival and development.