A 45-year-old white man with a history of neurogenic bladder and imperforate anus presented to our clinic complaining of a dark red discharge from the penis. He had undergone ileal loop urinary diversion at age 6 with the bladder left in situ. The fecal stream was diverted with an end colostomy in 1981. Cystoscopy revealed a 5 cm. sessile tumor on the left anterior lateral wall of the bladder. Examination with the patient under anesthesia showed no bladder fixation. Biopsy of the tumor revealed muscle invasive bladder adenocarcinoma. Metastatic workup was negative. We then performed a radical cystoprostatectomy (fig. 1). Microscopic evaluation of the specimen revealed grade III mucinous adenocarcinoma with extensive intestinal metaplasia of the bladder mucosa (fig. 2). The prostate, seminal vesicles, urethra and ureters were free of tumor. The patient experienced a satisfactory recovery. He declined adjuvant radiation therapy and chemotherapy. Followup imaging at 6 months showed no evidence of local recurrence or metastatic disease.