The patient with exstrophy in adult life.

One hundred and one cases of classical exstrophy with at least 18 years of follow-up are reported. There were 29 girls and 72 boys. Nine have died but only 3 of urological causes; 19 have been lost to follow-up at various times. In patients born before 1953 and in later patients with small bladders, primary diversion was done. In other patients primary closure was attempted with an 18% continence rate. Successful bladder closure produced a 25% incidence of any kind of renal damage. With diversion the incidence was 30% (colonic loop) and 75% (ileal loop). Sexual function is good. Six men have initiated pregnancies; 8 girls had 11 pregnancies, producing 9 normal children. Education, employment and family life have not been substantially affected.