Brock and O'Neill wrote in 1988 that the symptoms of bladder exstrophy create the impression that the patient has received a dissection of tissues along the midline from the umbilicus to the penis. In this case, there is a dissection of the skin and muscles of the anterior abdominal wall, the anterior wall of the bladder and the urethra. The tissues are pushed apart, like "the pages of an open book."