ABSTRACT
Contemporary estimates for the incidence of bladder exstrophy vary considerably. The aims of exstrophy and epispadias repair are: to place the bladder within the abdomen and ultimately to achieve urinary continence with preservation of renal function, to create a satisfactory genital appearance and near-normal function and to preserve or enable fertility. Bladder exstrophy presents at birth with a low-set umbilicus and a split rectus abdominis muscle attached on either side to separated pubic rami. Isolated male epispadias varies considerably in severity, from that which simply involves the glans of the penis to a much more severe abnormality involving the entire urethra, bladder neck, and sphincter complex. The rare female isolated epispadias includes a bifid clitoris, a short patulous urethra, and an open bladder neck, invariably resulting in incontinence. Exstrophy closure should only be undertaken in well-resuscitated infants and may be delayed for up to 24-48 hours to allow the mother to recover from the delivery.
