The role of urologist in ovarian cancer debulking surgery

Although spread of advanced ovarian cancer (OC) into the urinary tract was considered a contraindication for surgery until the last decade, advancement of oncological centers tries to perform these radical surgeries. Urologist plays a significant role during these surgeries in order to obtain an optimal cytoreductive surgery (CRS). The aim of debulking surgeries is to achieve radical resection of involved organs by eliminating macroscopic disease. If urinary organs are involved, patients' survival depends on tumor resection with free postoperative margins and without residual disease and the incidence of postoperative obstruction. Preoperative evaluation of the extent of tumor into the urinary tract or dilation of the renal tract caused by ovarian spread is considered challenging. First, urologists should aim to the decompression of the lower urinary tract by placing either ureteral stents or nephrostomy tubes. After initial decompression of ureteral obstruction, urinary surgeries should follow aiming to initial identification of ureters and reconstruction of ureteral lesions. Optimal CRS in cases of OC invading the urinary bladder can be achieved either by radical or by bladder-sparing surgical procedures. Furthermore, urologists should aim to the surgical management, pre- and postoperative evaluation of patients with advanced OC involving the kidney. Due to restricted knowledge on this topic, there are no current guidelines concerning the surgical approach of urinary organs during debulking surgeries for OC, while surgical treatment of these patients should follow guidelines for the management of advanced OC invading other types of organs.