The pelvic exenteration operation
Pelvic exenteration is a long operation that takes about eight hours. It’s usually carried out by two or more surgeons, who work together to remove the cancer and reconstruct or replace some of the organs that are taken away.
The surgeons involved in the operation include a specialist cancer surgeon (oncological surgeon) and a plastic surgeon (reconstructive surgeon).
Depending on the type of pelvic exenteration you have, you may have a urostomy and/or a colostomy made. Some women may also have a new vagina made (vaginal reconstruction).
If the bladder is removed, you’ll need a new place for urine to leave your body. The surgeon will make a new opening (stoma) on your tummy wall for this, called a urostomy.
There are different types of urostomy. Your surgeon will explain which one is most suitable for you.
This is the most common type of urostomy. After the operation, you’ll wear an external bag to collect your urine.
The surgeon removes a section of the small bowel and joins the tubes coming from each of the kidneys (ureters) to one end of it. They bring the other open end of the bowel out through a small opening (stoma) in the skin of the tummy wall. Urine made by the kidneys will pass out of the body through this stoma.
You’ll wear a flat, watertight bag over the stoma to collect your urine. The bag will fill with urine, and you’ll need to empty it regularly. Your specialist stoma nurse will show you how to take care of it.
Continent urinary diversion (internal pouch)
With this type of operation, you don’t need an external bag to collect your urine. Your surgeon uses a piece of the small bowel to make a pouch that can store urine inside the tummy (abdomen). The pouch is connected to an opening (stoma) on the tummy wall. You empty urine from the pouch by putting a tube (catheter) into the stoma. This is called self-catheterisation.
If the lower part of the bowel (rectum) is removed, the remaining end of the bowel will be brought up to an opening (stoma) on the tummy wall. This is known as a colostomy. You’ll wear a bag over the stoma to collect bowel motions. Your specialist stoma nurse will show you how to change the bag and take care of the stoma.
We have more information on living with a stoma, which you may find helpful.
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This is not always done, but sometimes it may be possible to make a new vagina using tissue from other parts of the body. The surgeon takes a flap of muscle and skin from another part of your body, shapes it into a closed tube and stitches it into place. The blood vessels and nerves for the new vagina stay attached to the place the tissue came from, so the new vagina has feeling. When it heals, the new vagina is like the original in size and shape.
A specialist nurse will give you advice on how to care for a new vagina.