The indications for pelvic exenteration (PE) for urological origin include advanced prostate and invasive bladder cancers. PE can be performed with either curative or palliative intent, but all indications are associated with considerable morbidity and/or mortality. Symptoms from locally advanced disease can be debilitating and include hematuria, obstructive uropathy, severe pelvic pain, and, rarely, bowel obstruction. Management options for locally advanced prostate cancer are dependent on several factors such as the comorbidity of the patient and the adjacent structures that are involved. In advanced prostate cancer there may be local spread to surrounding structures including seminal vesicles, the bladder, and less commonly the rectum. Multicompartment exenterative surgery is infrequently practised and is reserved for aggressive management of either advanced, symptomatic prostate cancers or, less commonly, synchronous tumors of the rectum and prostate. Both advanced bladder and prostate cancers can cause severe debilitating symptoms including pain, dysuria, hematuria, and outflow obstruction.