Exstrophy and cloacal exstrophy.

Classic bladder exstrophy and cloacal exstrophy are grotesque anomalies in the eyes of young parents. An immediate evaluation by an experienced team is required to assess the variations in the condition and to devise a plan of treatment that can reassure the parents as to eventual prognosis and rehabilitation. This plan of treatment must include provisions for renal preservation, urinary control, cosmetic appearance, and sexual function. The newborn is usually normal in respect to nutrition and its cardiopulmonary state, and will tolerate surgery well. Passive parental immunity provides better resistance to intercurrent illness at this time than will be present in the later months of infancy. When applicable, the initial stages of surgery should be undertaken at birth when the pelvic ring can be approximated without osteotomy and the bladder mucosa has not deteriorated from inflammatory changes. Parental attitudes toward the child as well as successful reconstruction may both be best served by immediate surgery to begin reconstruction and reduce the visible defect.