Reconstructive surgery for patients with hypospadias, bladder exstrophy and cloacal exstrophy is challenging. Over the last few years, more and more data have become available concerning incidence and epidemiology, as well as short- and long-term results of surgical techniques. The tubularized incised plate urethroplasty for hypospadias repair continues to gain in popularity. However, the results of long-term studies of larger series supporting this enthusiasm are still missing. Buccal mucosa is more frequently used in complex hypospadias cases with good short- and long-term results. The one-stage approach of exstrophy repair seems to be promising. However, failures, which require very complex reconstructions, are also reported. Urodynamic studies demonstrated severe abnormalities of bladder function even in continent patients. Therefore, one must question the normality of voiding patterns, and the price to be paid in achieving continence for patients with exstrophy. Achievement of continence for urine and stool is possible for patients with cloacal exstrophy. The colon should be preserved and should not be used for bladder or vaginal reconstruction. The incidence of neoplasia in patients with bladder exstrophy seems to be higher than expected. However, only one cohort study is presently available.