Kato K, et al. - Experts described the details of a procedure for modified posterior pelvic exenteration (MPPE) surgery necessitating intestinal and urinary reconstruction. A 55-year-old woman who was suspected with a tumor-infiltrating the left pelvic side-wall underwent an up-front cytoreductive surgery for FIGO stage IIIC (pT3c N1 M0) ovarian cancer. During a laparotomy, tumor involvement of the left ureter and internal iliac vessels was recognized and an MPPE with pelvic side-wall resection involving a partial ureterectomy was thus done. Following the resection of the pelvic and omental tumors, colorectal and vesicoureteral anastomoses were done. For cases with ovarian cancer involving the pelvic side-wall, an MPPE needing intestinal and urinary reconstruction was discovered to be both feasible and safe and could be thought of. The postoperative bladder function was conserved. Nonetheless, in some individuals undergoing an MPPE combined with pelvic side-wall resection, complexity in spontaneous voiding following surgery transpires and self-intermittent catheterization is required. In the former study of individuals with ovarian and endometrial cancer, the influence of MPPE with or without nerve preservation on the bladder function was assessed. From the early postoperative period, all individuals with bilateral nerve-sparing surgery had adequate micturition. Though 40% of the individuals with unilateral nerve-sparing surgery had trouble in spontaneous voiding and required intermittent catheterization, voiding ability of them revised and no self-catheterization was needed 3 months following surgery. The evaluation of patient questionnaires suggested that in both groups at 6 months, the bladder function was satisfactory. Cases with bilateral nerve-sacrificing surgery accused of neurogenic bladder needing self-catheterization even 6 months following surgery. Thus, to evaluate the bladder function following MPPE to the extent of pelvic autonomic nerve preservation, cautious follow-up is needed.