A fetus or newborn with exstrophy is often a surprise to both the family & the physician caring for the child. The distraught parents need reassurance at this stage. Unfortunately, because of the rarity of bladder exstrophy, many health care providers do not have experience and knowledge of this disorder and, yet, are asked to counsel prospective parents of these patients. The parents should be educated by a physician with a special interest and experience in managing cases of bladder exstrophy. An exstrophy support team should also be available and should include a pediatric orthopedic surgeon, pediatric anesthesiologist, pediatrician, social workers, nurses with special interest in bladder exstrophy, and a child psychiatrist with expertise and experience in genital anomalies (Cacciari A, et al., 1999). Repair is best to be done in a high volume hospitals (Nelson, 2005). Satisfactory long-term outcome and life expectancy are possible with appropriate management.

In classic bladder exstrophy, most anomalies are related to defects, of variable extent, in the abdominal wall, bladder, genitalia, pelvic bones, pelvic floor muscles, ano-rectum, and rarely kidney & spine. Classic exstrophy can present with a wide range of phenotypic differences including bladder plate size, urethral length and width, degree of chordee and penile size (in males) & symphyseal diastasis. These anatomical differences must be addressed at time of reconstruction to provide the best functional & cosmetic results.

Exstrophy remains one of the most striking and challenging birth defects confronting physicians who specialize in the urologic care of children. Despite the innumerable operations that have been applied to the treatment of exstrophy, operations for exstrophy currently fall largely into two strategies. The first includes operations designed to remove the exstrophic bladder and replace it with a form of urinary diversion. The second includes reconstructive procedures designed to reconstruct the bladder either in multiple stages or in a single stage. Surgeon preference, patient anatomy, previous surgical procedures, availability of tertiary care facilities, and access to medical care all play a role in which operative procedures are chosen. No standard of care exists for this patient population. However, because of the complexity of exstrophy, specialists with an interest in the exstrophy-epispadias complex best manage these patients by tailoring their care to each patient's situation.