Types of pelvic exenteration

Your surgeon may not know what type of pelvic exenteration you need until they start the surgery. The type you have will depend on:

  • the type of cancer you have
  • where the cancer is in the pelvis
  • what treatments you have had before.

The different types are:

  • anterior exenteration
  • posterior exenteration
  • total exenteration.

Anterior exenteration

This operation involves removing organs in the front part of the pelvis. The surgeon will remove:

  • the bladder
  • the cervix
  • the ovaries
  • part or all of the vagina
  • the womb.

Usually urine (pee) drains from the kidneys, through tubes called ureters, to the bladder. Urine is stored in the bladder until you are ready to pass urine. After the bladder is removed, urine needs to leave the body in a different way. You will have a urinary diversion. The types of urinary diversion used after pelvic exenteration are urostomy and continent urinary diversion.

We have more information about urinary diversion in our bladder cancer content.

The surgeon makes an opening on the tummy (abdomen) called a stoma. When the bladder is removed, the surgeon connects the end of the ureters to this opening. Depending on the type of urinary diversion you have, you may wear a bag over the stoma to collect urine.

If the vagina was removed, sometimes the surgeon can make a new one. This is called vaginal reconstruction.

The female pelvic organs, showing the areas removed during anterior exenteration:

 The image shows a side view of a female pelvis. There are three small openings into the pelvis between the legs. The opening closest to the back of the body is called the anus. It leads up into a tube shaped space called the back passage or rectum. The opening closest to the front of the body leads up through a short narrow tube called the urethra. This leads into a rounded hollow organ called the bladder. The opening in the middle leads through a longer tube called the vagina. This leads into a hollow organ with thick walls called the womb. The lowest part of the womb is highlighted where it meets the vagina. The highlighted area is called the cervix. At the top of the womb, a thin short tube is shown leaving the womb. This is a fallopian tube. It leads to a small solid oval organ. This is an ovary. The womb sits behind and over the bladder. There is a shaded area covering the bladder, womb, cervix, ovary and vagina. This shaded area shows the organs that are removed in an anterior exenteration.

Posterior exenteration

This operation involves removing organs in the back part of the pelvis. The surgeon will remove:

  • the cervix
  • the ovaries
  • the womb
  • the lower part of the bowel (the rectum and sometimes the anus).

They may also remove part, or all the vagina. If this is done, sometimes the surgeon can make a new vagina. This is called vaginal reconstruction.

Usually stools (poo) leave the body through the rectum and the anus. After the rectum is removed, stools need to leave the body in a different way. The surgeon makes an opening on the tummy (abdomen) called a stoma. They connect the end of the bowel to this opening. This is called a colostomy. You wear a colostomy bag over the stoma to collect the stools.

The female pelvic organs, showing the areas removed during posterior exenteration:

There are three small openings into the pelvis between the legs. The opening closest to the back of the body is called the anus. It leads up into a tube shaped space called the back passage or rectum. The opening closest to the front of the body leads up through a short narrow tube called the urethra. This leads into a rounded hollow organ called the bladder. The opening in the middle leads through a longer tube called the vagina. This leads into a hollow organ with thick walls called the womb. The lowest part of the womb is highlighted where it meets the vagina. The highlighted area is called the cervix. At the top of the womb, a thin short tube is shown leaving the womb. This is a fallopian tube. It leads to a small solid oval organ. This is an ovary. The womb sits behind and over the bladder. There is a shaded area covering the womb, cervix, ovary, vagina, and rectum. This shaded area shows the organs that are removed in a posterior exenteration.

Total exenteration

This surgery involves removing all the organs in the pelvis. The surgeon will remove:

  • the ovaries
  • the womb
  • the cervix
  • part or all of the vagina
  • the bladder
  • the lower part of the bowel (the rectum and sometimes the anus).

Usually urine (pee) drains from the kidneys, through tubes called ureters, to the bladder. Urine is stored in the bladder until you are ready to pass urine. After the bladder is removed, urine needs to leave the body in a different way. You will have a urinary diversion.

The surgeon makes an opening on the tummy (abdomen) called a stoma. When the bladder is removed, the surgeon connects the end of the ureters to this opening. Depending on the type of urinary diversion you have, you may wear a bag over the stoma to collect urine.

Usually stools (poo) leave the body through the rectum and the anus. After the rectum is removed, stools need to leave the body in a different way. The surgeon makes an opening on the tummy (abdomen) called a stoma. They connect the end of the bowel to this opening. This is called a colostomy. You wear a colostomy bag over the stoma to collect the stools.

If the vagina was removed, sometimes the surgeon can make a new one. This is called vaginal reconstruction.

The female pelvic organs, showing the areas removed during total pelvic exenteration:

The image shows a side view of a female pelvis.  There are three small openings into the pelvis between the legs. The opening closest to the back of the body is called the anus. It leads up into a tube shaped space called the back passage or rectum. The opening closest to the front of the body leads up through a short narrow tube called the urethra. This leads into a rounded hollow organ called the bladder. The opening in the middle leads through a longer tube called the vagina. This leads into a hollow organ with thick walls called the womb. The lowest part of the womb is highlighted where it meets the vagina. The highlighted area is called the cervix. At the top of the womb, a thin short tube is shown leaving the womb. This is a fallopian tube. It leads to a small solid oval organ. This is an ovary. The womb sits behind and over the bladder.  There is a shaded area covering the bladder, womb, cervix, ovary, vagina and rectum. This shaded area shows the organs that are removed in a total exenteration.