Bladder exstrophy (BEX) represents a significant reconstructive challenge for the paediatric surgeon and urologist. There are several factors involved in the success of managing a patient with bladder exstrophy, and it is not solely based upon a successful operative closure in the neonatal period, even though we know that children requiring a redo closure fare less well in terms of urinary continence. It is paramount that treatment is undertaken by a bladder exstrophy specialist who has a thorough appreciation of the altered anatomy and a detailed knowledge of the evolution of bladder development, as well as increase in capacity and function throughout childhood and into adulthood. Justin Kelly made one of the most noteworthy contributions to the management of children with BEX when he first described in 1971 ‘a procedure for lengthening the phallus in boys with exstrophy of the bladder’, which we now understand universally as the ‘Kelly procedure’. The operation rapidly evolved into a combined genital reconstructive and continence procedure, and it is now likely the most widely adapted approach worldwide for managing bladder exstrophy.