The extreme rarity of the disease limits the surgical opportunities to practice the complex closure required in these patients. For this reason, patients have the best outcomes when the<unk>  closures are performed at high volume centers where surgical and nursing teams have extensive experience in caring for the disease. The highest volume center in the United States, and the world, is the Johns Hopkins Hospital in Baltimore, Maryland; they have seen over 1300<unk>  patients in the past 50 years. Upon delivery, the exposed<unk>  is irrigated and a non-adherent film is placed to prevent as much contact with the external environment as possible. In the event the child was not born at a medical center with an appropriate<unk>  support team then transfer will likely follow. Upon transfer, or for those infants born at a medical center able to care for<unk> , imaging may take place in the first few hours of life prior to the child undergoing surgery. Primary (immediate) closure is indicated only in those patients with a<unk>  of appropriate size, elasticity, and contractility as those patients are most likely to develop a<unk>  of adequate capacity after early surgical intervention. Conditions that are absolute contraindications despite<unk>  adequacy include duplication of the penis or scrotum and significant bilateral hydronephrosis. Surgery Watercolour drawing of ectopia vesicae in a man aged 23 years, after operation Modern therapy is aimed at surgical reconstruction of the<unk>  and genitalia. Both males and females are born with this anomaly. Treatment is similar. In males treatments have been: In the modern staged repair of<unk>  (MSRE) the initial step is closure of the abdominal wall, often requiring a pelvic osteotomy. This leaves the patient with penile epispadias and urinary incontinence. At approximately 2–3 years of age, the patient then undergoes repair of the epispadias after testosterone stimulation. Finally,<unk>  neck repair usually occurs around the age of 4–5 years, though this is dependent upon a<unk>  with adequate capacity and, most importantly, an indication that the child is interested in becoming continent. In some of the<unk>  reconstructions, the<unk>  is augmented with the addition of a segment of the large intestines to increase the volume capacity of the reconstructed<unk> . In the complete primary repair of<unk>  (CPRE) the<unk>  closure is combined with an epispadias repair, in an effort to decrease costs and morbidity. This technique has, however, led to significant loss of penile and corporal tissue, particularly in younger patients. In females treatment has included: Surgical reconstruction of the clitoris, which is separated into two distinct bodies. Surgical reconstruction to correct the split of the mons, redefine the structure of the<unk>  neck and urethra. Vaginoplasty will correct the anteriorly displaced vagina. If the anus is involved, it is also repaired. Fertility remains and women who were born with<unk>  usually develop prolapse due to the weaker muscles of the pelvic floor.
Bladder exstrophy
Cloacal exstrophy
Hypospadias
Omphalocele
Rectocele
Choanal atresia
Gastroschisis
Imperforate anus