Closure of the exstrophied bladder should be performed, ideally, within the first 48 hours of life, if at all possible. Closure after that time usually does require iliac osteotomies. At the initial operation in both boys and girls, an attempt is made to more normalize the appearance of the external genitalia. Boys actually have normal sized organs which are splayed out on the bones and when the bones are brought together, the corporal bodies of the penis are as well, and the penis has more length. In girls, the halves of the clitoris are also put together.
Patients are usually in traction for approximately three weeks following the operative procedure.
The goal of this staged reconstruction is to have patients with a normal urinary tract, satisfactory external genitalia, and adequate dry intervals. Some children may require clean intermittent catheterization to adequately empty their bladders. Recently, the Federal Drug Administration released for general use a collagen substance which can now be injected at the neck of the bladder to increase resistance and continence. Urinary control is often further improved at puberty with the growth of the prostate. Adolescence is sometimes a difficult time for boys.