Introduction: Bladder exstrophy (BE) is a rare congenital anomaly, affecting 2.1 to 3.3 per 100,000 live births, and is frequently associated with inguinal hernias, particularly in males. Optimal timing for hernia repair remains debated, with approaches including concomitant repair during bladder closure or symptomatic repair. This study aims to systematically evaluate the timing for inguinal hernia repair in BE according to the current literature.

Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024609829). Searches in PubMed, Web of Science, and Scopus identified studies on inguinal hernia repair in BE. Fourteen studies encompassing 1042 BE patients met the inclusion criteria.

Results: Of the 1042 patients, 537 (84 % male) underwent inguinal hernia repair. Concomitant inguinal hernia repair (CIH) was performed in 38 % of cases, with bilateral repair required in 67 %. The heterogeneity in study design, surgical techniques, and follow-up limits direct comparisons between approaches.

Conclusion: Given the high prevalence of inguinal hernias in BE patients, concurrent bilateral groin exploration with selective hernia repair when appropriate during primary exstrophy surgery may represent a practical approach to reduce procedural burden and future interventions. However, due to the study design and recurrence rates following CIH, further research is needed to refine surgical techniques and optimize patient selection.