Bladder exstrophy and epispadias complex (BEEC) presents one of the most fundamental challenges in pediatric urology. The surgical reconstruction consists of closure of the exstrophic bladder, repair of the epispadias and bladder neck reconstruction with the goal of achieving safe upper tracts, urinary continence and acceptable cosmesis. The procedure can be separated into steps as in the staged repair, or as with the Complete Primary Repair of Bladder Exstrophy (CPRE) described herein, all three of the surgical stages are completed at the initial repair. This chapter will detail the evolution of the CPRE and a step-by-step depiction of the key steps to facilitate safe repair. We believe that the evolution in the procedure is reducing the risk of dehiscence, bladder neck stricture or corporal injury which are the feared complications of any exstrophy surgery. We will also detail the long-term outcomes of the current repair and expound on our philosophical approach to incontinence as well as concerns with cosmesis and sexual function.