Abstract Purpose To determine the optimal surgical approach in achieving complete urinary continence with preservation of the upper urinary tract in the exstrophy-epispadias complex we reviewed the records of patients treated at our institution. Materials and Methods From 1968 to July 1994, 115 patients with bladder exstrophy/incontinent epispadias were treated of whom followup was available for 104 and 2 died of causes unrelated to urinary diversion. Mean followup is 16.7 years. In 43 of the 102 patients surgery was primarily performed at our institution (urinary diversion in 39, a modified Young-Dees procedure in 1 and sling plasty in 3). In another 59 patients urinary diversion was done secondarily after therapy elsewhere (bladder closure/bladder neck reconstruction in 34 and failed urinary diversion with incontinence in 22). Urinary diversion was performed in 49 patients, a Young-Dees procedure in 7 and genital reconstruction alone in 3. Results The present continence rates are 96 percent for the rectal reservoir, 97 percent for the Mainz pouch I and 67 percent for the modified Young-Dees augmentation. Upper tracts have remained stable and no bowel neoplasms have developed. Conclusions Rectal reservoirs represent our urinary diversion of choice. After failed reconstruction/insufficient anal sphincter a Mainz pouch I is constructed and when the upper tract has deteriorated a colon conduit is created.