Purpose:To determine the safety and efficacy of intraoperative magnetic resonance imaging (MRI) guided surgical reconstruction of bladder exstrophy for identification of the urogenital diaphragm fibers and the thickened muscular attachments between the posterior urethra, bladder plate and pubic rami.Methods:Institutional review board and Food and Drug Administration approval was obtained for use of Brainlab® (Munich, Germany) intraoperative MRI-guided navigation of the pelvic floor anatomy during closure of CBE and CE at the authors’ institution. Pre-operative pelvic 3D MRI was obtained one day prior to closure in patients having pelvic osteotomies. Intraoperative registration was performed after pre-operative planning with a pediatric radiologist utilizing five anatomic landmarks immediately prior to initiation of surgery. Accuracy of identification of pelvic anatomy was assessed by two pediatric urologic surgeons and one pediatric radiologist.Results:Forty three patients with CBE and four patien...