Introduction: The surgical treatment of bladder extrophy presents a major problem, particularly in delayed admitted cases and in those with a small bladder plate as well as failed cases of bladder extrophy closure. Materials and Methods: In a study on fourteen out of the thirty cases of bladder extrophy, a rectosigmoid pouch was separated from the colon; the ureters were then implanted in the pouch with colon pull-through inside the reconstructed bladder (“ rectosigmoid pouch” ) with complete separation of urine and stool. The operation was carried out in 3 stages. Of these 14 patients only seven underwent the 3 stages. Result: In the follow-up study after 20-40 years, of the seven patients that underwent all three stages, all of them were enjoying an active life with satisfactory growth and development. Conclusion: In the absence of any better options for the treatment of bladder extrophy, the above mentioned operative procedure can be recommended as it is safe and satisfactory with relatively good long term results. This paper was presented at the 8th Annual Meeting of the German Association of Pediatric Surgeons in Jenna, Nov. 17-19, 2011, Section “ Pediatric Urology.