Orthotopic continent urinary diversion using various segments of the intestinal tract is used as a means of urinary tract reconstruction after radical cystectomy for muscle invasive bladder cancer or simple cystectomy for palliation of benign bladder conditions. Neobladders have been created using segments of distal ileum, ascending colon and sigmoid colon.1 Neobladder reconstructions have been well studied and the complication profile has been described in the literature.2 Long-term complications include stone formation, recurrent urinary tract infections and metabolic abnormalities.3 Spontaneous neobladder rupture is a rare complication and is often not included in descriptions of neobladder outcomes.4,5 Neobladder construction is becoming more frequently used as a means of continent urinary diversion, particularly in younger, motivated patients with long life expectancy, to improve quality of life after cystectomy.2,3,6 No guidelines or recommendations exist to direct management of a ruptured neobladder. Neobladder rupture results in an intraperitoneal urine leak and operative management with laparotomy, abdominal washout and repair is usually performed. The trend for operative intervention is based on trauma guidelines for the management of intraperitoneal bladder injuries.7 We report a case that was managed non-operatively with catheter drainage, and propose a guideline to identify patients suitable for conservative treatment and outline a treatment strategy to aid clinicians.