Bladder exstrophy is a rare congenital abnormality in which the child is born with a lower abdominal wall defect with herniation of the bladder. The bladder is an open plate and bladder mucosa faces outward ventrally, with urine draining from the ureteric orifices onto the bladder plate. Similarly, the urethra is not tubularized but remains an epispadias urethral plate. Diastasis of the symphysis pubis causes an abnormal shape of the pelvis and penis or bifid clitoris. Bladder function may remain impaired following surgical closure of the bladder and abdominal wall, leading to storage and voiding problems. Vesico-ureteric reflux is common with an increased risk of urinary tract infections. Renal function may be compromised if bladder function is not managed properly. Frequently, additional surgical procedures are needed to achieve (pseudo)continence and satisfactory cosmesis. Abnormal genital appearance and sexual function may lead to psychological problems. Life-long follow-up is warranted.