summary Bladder Exstrophy is a rare congenital disorder that involves the musculoskeletal and genitourinary systems and may present with several pelvic abnormalities. Diagnosis can be confirmed with pelvic radiographs revealing pubic rami diastasis, shortened pubi rami, and acetabular retroversion. Treatment is surgical with staged multidisciplinary reconstruction. Epidemiology Incidence classic exstrophy 1/40,000 infants diagnosed with this condition cloacal exstrophy 1/200,000 infants with intestinal track involved as well Etiology Pathology abnormal anterior rupture of the cloacal membrane early in the embryonic period mesenchymal ingrowth into the abdominal wall is also inhibited altered migration of sclerotomes that comprise the anterior elements (pubis) Associated conditions family history should be sought out as often associated with other conditions Presentation Symptoms a thorough history and a complete examination are essential urinary system infection(s) Physical exam genitourinary system exposed bladder musculoskeletal acetabuli are ~12 degrees retroverted login to view 1 more bullet waddling gait with external foot progression Imaging Radiographs recommended views obtain AP pelvic radiograph findings pubic rami diastasis shortened pubic rami acetabular retroversion Treatment Goal of treatment close abdominal wall achieve urinary continence normal renal function Operative staged multidisciplinary reconstruction indications login to view 1 more bullet multidisciplinary approach login to view 2 more bullets components login to view 8 more bullets Technique Staged multidisciplinary reconstruction technique stage I login to view 1 more bullet stage II login to view 1 more bullet stage III login to view 1 more bullet pelvic osteotomies login to view 11 more bullets Complications Recurrent pubic diastasis Common whether or not osteotomy was performed Does not appear to impact activity level Complications of anterior innominate osteotomy wound dehiscence transient femoral nerve palsy