Abstract: Objective To evaluate the efficacy of reconstruction of the pelvic floor through laparoscopic radical cystectomy with orthotopic ileal neobladder. Methods Retrospective analysis was performed using clinical data from 108 male patients who underwent laparoscopic radical cystectomy with orthotopic ileal neobladder from January 2015 to June 2018 in Department of Urology, the Affiliated Hospital of Xuzhou Medical University. There were 42 patients in a reconstruction group and 66 patients in a routine group. The reconstruction group underwent reconstruction of the pelvic floor with the pre-retained peritoneum through laparoscopic anastomosis of the new bladder and ureter, and preservation of the neurovascular bundle. Results The reconstructive group presented improved gastrointestinal tract recovery time, postoperative drainage days, and postoperative hospitalization stay than the conventional group (P<0.05). After 3 months of follow-up visits, the daytime and nighttime urinary control satisfaction rates were significantly higher in the reconstruction group than in the routine group (P<0.05). The satisfaction rate of discharge was 95.2% in the reconstruction group, which was significantly higher than 84.8% in the conventional group (P<0.05). Conclusions Laparoscopic radical cystectomy combined with orthotopic ileal neobladder can improve the efficacy of pelvic floor reconstruction, which will facilitate rapid recovery, improve the function of the new bladder and the satisfaction rate of hospitalization.