The author discusses widely the historical evolution of the rectal bladder; he reports on his experience of over 370 cases and outlines the reasons why he prefers the rectum as a new urinary reservoir. He points out the indications to reconstruct the rectal bladder after total cystectomy and as a palliative procedure in cases affected by congenital or acquired pathology. He calls the attention to the technical modifications he has introduced, modifications which represent an improvement of the operative method. Further on the author outlines and discusses the possible post-operative complications and the functional results of the rectal bladder in relation also to the intestinal tract. The author concludes stating that the rectal bladder operation may be proposed and performed in all cases in which a full radicality is required. Reporting upon the results, the author is convinced that they are very satisfying so that the rectal bladder, at present, represents an urinary reservoir with functional characteristics nearer to the normal bladder.