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Bladder exstrophy requires staged reconstruction to achieve control over bladder function. In case of failure, bladder neck closure with augmentation enterocystoplasty and appendicovesicostomy is a good surgical option. We report the case of a girl born with bladder exstrophy who, despite multiple surgical reconstructions in childhood, developed severe stress incontinence with contracted bladder and recurrent urinary tract infections during adolescence. The patient had a large abdominal pannus and in order to realize the appendicovesicostomy, we combined this intervention with a body contouring abdominoplasty to achieve tension free closure.