The primary treatment of gynecological malignancies has considerably evolved over the last century, with a move to less aggressive procedures when appropriate. However, gynecological malignancies comprise a heterogeneous group, with varying treatment options. The choice of reconstructive method for urinary and fecal diversion is crucial, as most patients have been irradiated with high doses or had prior surgery for their primary neoplasm. Patient characteristics, such as age and comorbidity, also affect the choice of urinary diversion, especially when opting for a continent reconstruction in the setting of an anterior exenteration for a gynecological cancer. For patients with advanced gynecological tumors requiring both urinary and fecal diversion, that is, two stomas, a double-barreled colostomy has been popularized. The optimal localization of the urinary stoma is an integral part of the preoperative preparation and of critical importance to avoid postoperative difficulties with stoma accessories or emptying a continent cutaneous diversion.