Summary Children with exstrophy may be seen at school age with a history of (1) anterior, primary, vesical closure having been performed in early infancy and (2) repeated revisions of the operation having been carried out in subsequent years in an attempt to attain continence. Fifteen such patients who had an average of 3.4 attempts at closure but remained (1) completely incontinent or (2) showing upper urinary tract deterioration, or both, were subjected to a form of intestinal diversion, namely, vesicoileosigmoidostomy. Evaluation of the degree of upper urinary tract protection provided by this complex conduit system is premature. Its theoretic advantages over other intestinal diversions may not prove of practical value. However, among those patients with near normal upper urinary tracts prior to this procedure, there has been no progressive upper tract changes. During four years of postoperative observation, the degree of continence obtained and consequent social rehabilitation possible, have been impressive.