Cloacal exstrophy, also known as OEIS, involves an anterior abdominal wall defect and a spectrum of urinary, gastrointestinal, skeletal, spinal, and genital anomalies. The initial goal of genitourinary reconstruction is to bring the two hemibladder plates together by excising the omphalocele and separating the cecal plate from the bladder halves. The cecal plate is tubularized and placed in continuity with the blind-ending hindgut, which is exteriorized and matured as an end colostomy. The second surgical step is similar to reconstruction of classic bladder exstrophy, with steps including bladder closure, reconstruction of external genitalia, and approxi­mation of pubic rami with the aid of osteotomies. Given the high prevalence of spinal defects in the cloacal exstrophy population, volitional voiding is typically not an option. When patients and parents/caregivers are socially ready and properly counseled, bladder neck closure/reconstruction and continent catheterizable chan­nels may be created with or without enterocystoplasty in order to achieve urinary continence. There is high prevalence of Müllerian abnormalities, which are typi­cally able to be properly assessed and reconstructed around the time of adolescence. Modern medical management and rened surgical techniques have enabled longer life expectancies for patients with cloacal exstrophy, with reduced rates of malnutri­tion, sepsis, and renal failure. As patients are surviving childhood and living to adulthood, continual efforts must be made to improve long-term outcomes and quality of life.