The primary reconstructive surgery for bladder exstrophy is the best chance for a good outcome. Failure of the primary procedure may occur in the form of bladder prolapse, complete dehiscence, vesicocutaneous fistula, outlet obstruction or any combination of factors along with loss of urethra, corpora or glans/clitoris. A failure is detrimental to subsequent genitourinary reconstruction, urinary continence and eventually the quality of life. The reason is usually multifactorial, a combination of pre-operative, technical and post-operative factors. A failed exstrophy repair can be dealt with in one of the following ways: delayed redo repair in a single stage or staged manner, redo bladder closure with concomitant bladder augmentation, excision of the bladder and continent urinary diversion or creating a urinary conduit. The essential principles to bear in mind are radical dissection to free and place the bladder, bladder neck and urethra as one unit deep in the pelvis with osteotomies, secure post-operative immobilisation, adequate sedation and pain relief. Osteotomies significantly improve the success rates in terms of the closure. However, multiple re-operative surgeries can reduce the chances of attaining a good bladder capacity, and long-term continence rates are at best around 50%. Hence, it is imperative that the decision about the procedure chosen weighs in all the factors, and the chance of redo repair is provided with full disclosure in carefully selected patients.