Therefore, female gender assignment is the recommendation in most boys born with cloacal exstrophy. Girls also can present with a separated clitoris, a bifid uterus, a duplicate vagina, or an exstrophic vagina. Management Upon recognizing a patient with exstrophy, either antenatally or immediately upon birth, referral to surgical specialists at tertiary centers who are experienced should be made without delay. Although bladder exstrophy is not usually a life-threatening entity, severe cloacal exstrophy may be. Surgical closure of bladder exstrophy is generally desirable in the first 72 hours of life .
Early closure is easier because of pliability of the bony structures of the pelvis in young infants.
The maternal hormone relaxin is thought to be responsible for this bony laxity. Pelvic osteotomy, which aids in pelvic and abdominal wall closure, may be avoided if closure is performed early. Before closure the bladder should be covered with a plastic covering, such as plastic wrap, to protect it from outside irritants. Petroleum jelly gauze or saline soaks are to be avoided because they may dry out and stick to the bladder mucosa. The umbilicus should be ligated with a suture and not a plastic clamp to avoid bladder mucosal trauma.