Like in male patients, selection of female patients for an orthotopic neobladder is important from an oncological and functional standpoint. The anatomy and the behavior of the isolated urethra in women had to be restudied because of the shorter urethra, the absence of the prostate, an undefined level of urethral dissection, and the different anatomy of the urethral sphincter-system. Retrospective long-term observations of female patients with primary bladder cancer revealed a 2% incidence of secondary urethral tumors in women. The only significant risk factor for urethral tumor involvement was primary bladder cancer at the bladder neck. Any type of gastrointestinal segment may be used for creating a pouch in women. As a result of an approximately 15% possibility of urinary retention or larger post-void residuals, the use of an efficient antireflux valve mechanism seems prudent. Clinical experience in an increasing number of women confirms the preliminary favorable results. Despite the selection criteria outlined in this article, most women can safely and rewardingly be offered an orthotopic neobladder.