The congenital defect in classic bladder exstrophy (CBE) results in significant aberrations in typical urinary tract anatomy. This leads to frequent urinary incontinence despite a successful primary repair which contributes to a decreased patient-reported quality of life. Patient selection remains the most important tool for achieving continence after reconstructive surgery. Surgical options to improve urinary continence are procedures aimed at bladder outlet insufficiency and decreased bladder capacity. Various bladder outlet surgical techniques have been introduced aimed at preservation of bladder with the patient emptying the bladder either voiding per urethra or with use of clean intermittent catheterization. The creation of a continent catheterizable channel utilizing the Mitrofanoff principle has been revolutionary in lower urinary tract reconstruction when the bladder outlet is ablated. Augmentation cystoplasty is employed to address insufficient bladder size and storage characteristics in significant number of patients. At times, urinary diversion may be the optimal choice in the pursuit of urinary continence when the bladder is deemed unusable by the surgeon. Postoperative complications following these continent reconstructive surgeries necessitate chronic lifelong urologic follow-up.