The exstrophy complex: Bladder and cloacal exstrophy

The care of a newborn with the exstrophy-epispadias complex presents a formidable challenge to the pediatric surgical community. The approach to these children is a multi-disciplinary effort involving multiple subspecialties including urologists, surgeons, orthopedists, pediatric anesthesiologists and specialty nurses. Advances in the basic and clinical sciences in the past two decades have yielded insight into the embryologic, genetic, and the physiology of exstrophy. Despite multiple approaches to the surgical management of the exstrophic patients are used throughout the world, the critically important part of the surgical care is a successful primary closure. The best long-term outcomes can only be achieved with a successful primary closure, and each failure decreases a patient's chance at voided continence. This chapter aims to examine all aspects of the exstrophy patient including the surgical management and long term prognosis.