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Bladder exstrophy is a rare congenital anomaly that requires a complex multidisciplinary approach and multi-stage surgeries. We report two cases of bladder exstrophy, our management, and outcomes. Case 1 is a 17 days old female with lower abdominal mass on birth. Pelvic radiography showed a 7 cm pubic diastasis. Bladder closure and bilateral pelvic osteotomy with advancement flap were performed. Case 2 is a 1 year old female with lower abdominal mass and urinating problem. Pelvic radiography showed pubic diastasis. Bladder closure and anterior innominate osteotomy were performed. Both patients had satisfactory follow-up. Management goal is closure of the bladder with preserved renal function and satisfactory cosmetic and function of the genitalia. We showed that pelvic osteotomy combined with external fixation provided better wound healing. Pelvic osteotomy combined with external fixation resulted in better wound healing. Further research is required to determine best approach to osteotomy.