A Realistic Look at Exstrophy of the Bladder

SUMMARY Twenty‐eight cases of exstrophy of the bladder over a 32‐year period were divided into groups, 7 cases from 1936 to 1951 and 21 cases subsequent to 1951. Analysis revealed that ureterosigmoidostomy using the technique described is a very satisfactory procedure. Primary closure is facilitated by iliac osteotomy but incontinence and reflux remain a problem. A pelvic sling was found superior to a plaster cast following osteotomy. Reconstruction of the genitalia is a necessary procedure regardless of the primary surgery. A pull‐through epispadias repair in the male is described which preserves fertility and sexual function. The ileal conduit was utilised as a back‐up procedure.