Having pelvic exenteration

Pelvic exenteration is a long operation (surgery). It usually takes about 8 hours, but it can take longer. Two or more surgeons will work together. These could include:

  • a urologist – a surgeon who specialises in the urinary system
  • a colorectal surgeon – a surgeon who specialises in bowel cancers
  • a gynaecological oncologist – a surgeon who specialises in gynaecological cancers
  • a plastic surgeon – a surgeon who specialises in reconstruction.

Depending on the type of pelvic exenteration you have, you may have a urostomy, a colostomy, or both. Some women may also have a new vagina made (vaginal reconstruction).

Urinary diversion

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 will need to leave the body in a different way. You will have a urinary diversion.

There are different types of urinary diversions. Your surgeon will explain which one is most suitable for you.

Urostomy

This is the most common type of urinary diversion. It is sometimes called an ileal conduit. The surgeon uses a piece of the small bowel. They join the two ureters to one end of it. The other end is brought out through a small opening in the tummy (abdomen) called a stoma. Urine will leave the body through the stoma.

Urostomy
Urostomy

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You wear a bag over the stoma to collect urine. You will need to empty the bag regularly. Your stoma nurse will show you how to change the bag and take care of the stoma.

Continent urinary diversion

This is like a urostomy, but you do not need a bag to collect your urine. Your surgeon uses a piece of the small bowel to make a pouch. This pouch holds urine inside the tummy (abdomen). The surgeon attaches the ureters to the pouch. The pouch is connected to an opening in the tummy called a stoma. Urine is emptied from the pouch by putting a tube (catheter) into the stoma. This is called self-catheterisation.

Continent urinary diversion
Continent urinary diversion

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Living with a stoma

Nurse Gail Kerr talks about stomas and preparing stoma patients physically and psychologically for having a stoma.

About our cancer information videos

Living with a stoma

Nurse Gail Kerr talks about stomas and preparing stoma patients physically and psychologically for having a stoma.

About our cancer information videos

Colostomy

Usually stools (poo) leave the body through the rectum and the anus. After the rectum is removed, stools will 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.

A stoma
A stoma

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You wear a colostomy bag over the stoma to collect your stools. Your specialist stoma nurse will show you how to change the bag and take care of the stoma.

If the anus is not removed, some people can have a small surgery in the future to remove the stoma. The bowel is re-joined to the anus. This operation is not often done. Your surgeon can tell you if it is possible for you.

We have more information on living with a stoma, which you may find helpful.

A stoma and stoma bag
A stoma and stoma bag

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It’s getting used to going out with stoma bags and changing them in a public toilet and things like that. Each time it becomes easier.

Taylor

Vaginal reconstruction

During the operation you may have part or all of the vagina removed. The surgeon can make a new vagina using tissue from another part of the body. This is called vaginal reconstruction. Whether this operation is suitable for you will depend on your health and what cancer treatments you have had before. It is also your decision. Some women choose not to have this.

Some women who have reconstruction may be able to have vaginal sex, but it is not always possible.

Vaginal reconstruction may be done by a plastic surgeon during pelvic exenteration. Or you and your surgeon may decide to do it as a separate operation, once you have recovered.

The surgeon uses flaps of skin, fat and sometimes muscle, from another part of the body. These are shaped into a closed tube and stitched into place. The new vagina may have feeling (sensation), but this is usually very different to what you could feel before.

As the new vagina heals, there might be scarring. This can make it smaller and less stretchy. Your hospital team may recommend you use vaginal dilators to help with this. Dilators are tampon-shaped plastic tubes of different sizes, which you use with a lubricant. Sometimes the surgeon may do another small operation to reduce the scarring.

Your specialist nurse can support you and talk to you about any concerns you have about the new vagina.

Not everyone choses to have vaginal reconstruction. If you have a partner, it can be helpful to talk to them about your options and the possible changes. You can also talk to your surgeon or specialist nurse about whether it is right for you.

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