Supul Hennayake

The University of Manchester

Origins of the lower vagina and role of androgens from 20 years’ experience with genitoplasty for 46XX classical congenital adrenal hyperplasia (CAH) Based on the traditional belief that the lower vagina does not form owing to excess androgens in utero, extensive dissections are undertaken to bring the vagina down to the skin level in 46XX CAH indi...

Is there reversal of virilisation after commencing medical replacement therapy for 46XX classical congenital adrenal hyperplasia (CAH)? Genitalia appear larger and swollen in all neonates due to the circulating maternal hormones and this subsides spontaneously over few weeks or months. Additionally, general growth of the rest of the body outpaces a...

Introduction: Anatomical studies of hypospadias show failure of zipping-up of histologically normal urethral plate and corpus spongiosum. With the commonly utilized substitution urethroplasties for proximal hypospadias, a reconstructed urethra of just an "epithelial-lined tube" with no spongiosal support, is apt to long-term urinary and ejaculator...

In Manchester, feminising genitoplasty is offered to children with 46XX Congenital Adrenal Hyperplasia (CAH) when there is a single perineal opening and/or enlarged clitoris. Our aims are to describe the anatomical reconstructive technique and present long-term outcomes. Our hypothesis is that ‘the common channel (CC) length and distance to the vag...

IntroductionOptical balloon ports offer quick, easy and well controlled retroperitoneal access. However, the relatively long tip of the port in small children requires special consideration. We report our 5-year experience with regards to safety, efficacy and advantages with optical balloon ports over conventional ports in retroperitoneal laparosco...

Introduction Urinary duplication systems occur in approximately 1% of the population, and may present with recurrent UTIs, incontinence, or be incidentally detected on imaging. DMSA (dimercaptosuccinic acid) imaging is used in these patients to assess split renal function. If found significantly reduced in a single moiety, children may be offered h...

Extended Summary Objective To analyse the outcomes of retroperitoneoscopic upper and lower moiety hemi-nephroureterectomy (HNU) and to assess the different variables that may have an impact on outcome; remnant moiety damage, morbidity and the need for secondary surgery. Methods Prospectively recorded data of retroperitoneoscopic HNU’s performed b...

Laparoscopic pyeloplasty (LP) is a standard, but demanding operation. According to the European Association of Urology guidelines this procedure scores 13 out of 18 on the difficulty scale [1]. Articulating instruments, 3D video systems and robots may facilitate complex suturing of the ureteropelvic anastomosis at higher costs [2,3]. Magnetic compr...

Introduction Acute scrotal pain is a common problem in children. Amongst the various causes, only testicular torsion (TT) needs urgent, and arguably any, surgical intervention. However TT accounts for only approximately 25% of cases. The diagnosis of TT is currently based mainly on history and clinical examination in the UK. Objective We sought to...

Background The epidemiology and risk factors for paediatric urolithiasis (UL) in developed countries are evolving, with increasing rates of metabolic stone-formers. In the United Kingdom (UK), only a single London cohort has been studied in the past three decades. Regional disease patterns across the UK remain unknown. UL has been associated with a...

Introduction: Müllerian ducts regress in males under the effect of anti-Müllerian hormone (AMH), produced by pre-Sertoli cells. Müllerian duct remnants (MDRs) persist in 46,XY DSD due to AMH deficiency or receptor insensitivity, or gonadal dysgenesis (asymmetric 45,XO/46,XY, partial, or complete). Cases may present with various combinations of prox...

Literature review of the prognosis and outcomes of conservarive (non-operative) management of duplex system ureterocoeles, and presentation of a prospectively-collected case series at the Royal Manchester Children's Hospital from 2002 to 2017. We hypothesise that antenatally detected patients, observed closely for UTI and placed on antibiotic prop...

Background The incidence, aetiology and management of paediatric urolithiasis is changing in developed nations. Since 2003, no authors have characterised the evolving epidemiological patterns of disease in the United Kingdom (UK). Aims To assess the demographics and presenting features of paediatric urolithiasis, defining the incidence, aetiology,...

We describe the successful use of an osmotic self-inflating tissue expander for complex pediatric hypospadias repair. A 5-year-old boy, who had undergone previous hypospadias repair and subsequent fistula repair, presented with significant rotation of the penile shaft, with extensive scar tissue but insufficient native penile shaft skin for redo su...

Isolated urogenital sinus can cause distended bladder and/or vagina and may present with an abdominal mass and sepsis during infancy. Older children may present with recurrent urinary tract infections and hematocolpos. We describe a 3-year-old girl with recurrent urinary tract infections thought to be secondary to vesicoureteric reflux. On further...

In children, due to difficulty in diagnosing torsion of testis (TT), a high rate of negative scrotal explorations is seen worldwide. To assess the possibility of utilising ultrasound scan of scrotum (USS-S) to minimise this rate at the Royal Manchester Children's hospital, a prospective audit of USS-S findings when diagnosis of TT became doubtful w...

To assess the medium term outcome of hypospadias repair and preputioplasty with regard to foreskin retractility, and whether this could be predicted by assessing retractility at the end of the operation. The data were obtained from a prospectively maintained database regarding patients who had hypospadias repair with preputioplasty between January...

A prospective review of conservative management of primary non-refluxing megaureters (PM) was performed to determine the time taken for resolution (TTR) and complications. Patient details were obtained from a prospectively maintained database from January 1, 2003, to December 31, 2011. The clinical features of USS and MAG3 findings were analyzed. A...

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Approximately 200 cases of persistent Müllerian duct syndrome have been reported over the last 50 years and most authors suggest leaving the Müllerian remnant in situ because of the difficulty in dissection and the presumed absence of ri...

Teratomas are thought to arise from totipotent primordial germ cells (PGCs) Dehner (1983) which may miss their target destination Moore and Persaud (1984). Teratomas can occur anywhere from the brain to the coccygeal area but are usually in the midline close to the embryological position of the gonadal ridges Bale (1984), Nguyen and Laberge (2000)....

We assessed the role and long-term outcome of upper pole heminephroureterectomy in the treatments of non-functioning upper renal moieties in children with duplex kidneys. In a period of 10 years, forty-three patients (male: female ratio 6:37) underwent upper pole heminephroureterectomy; a total of 25 patients were diagnosed prenatally. Imaging moda...

Introduction: Two children presented with malignant hypertension due to complex reno-vascular malformations. The 7-min video shows the use of prone retroperitoneoscopy in both. PATIENT 1: A 6-year-old girl presented with convulsions and malignant hypertension. Captopril DMSA was suggestive of right renal artery stenosis. On formal angiography, the...

Purpose We report our experience on the use of Plasmakinetic for vascular and renal control in laparoscopic heminephroureterectomy (HNU). Material and Methods From June 2003 to September 2009, 58 consecutive HNU were performed by the same surgeon (SH) in 57 children (37 F, 20 M), aged from 5 months to 11.5 years (median 1.8 y). Thirty-two were you...

This study assessed the role and long-term outcome of lower pole heminephrectomy in the treatments of non-functioning lower renal moieties in children with duplex kidneys. In a period of 10 years 31 lower pole heminephrectomies were performed in 30 patients with duplex systems. Eight patients were diagnosed prenatally, 24 patients (80%) presented w...

The lateral approach is more widely used in retroperitoneoscopic (RP) heminephroureterectomy (HNU) due to familiar orientation and ease of conversion. The prone approach however gives early and easy access to the vascular pedicle. The main reason for not adopting a prone approach more widely is the perceived difficulty in lower ureteric access. We...

Purpose The lateral approach is more widely used in retroperitoneoscopic renal surgery due to familiar orientation and ease of conversion. We present a series of 30 heminephroureterectomies (HNU) where prone approach was utilised extremely effectively with no conversions and low complications. Material and Methods From November 2003 to October 200...

The authors compared the cost of laparoscopic nephrectomy to open nephrectomy in the pediatric age group. One hundred seventeen consecutive laparoscopic nephrectomies performed by a surgeon with extensive experience with this approach between April 2003 and August 2006 were included. A control group of 24 consecutive open nephrectomies performed by...

We present 2 patients who had a solitary kidney visualized on ultrasound imaging and experienced constant urinary dribbling. Further imaging modalities defined the anatomy and visualized the contralateral kidney and ectopic ureter causing the dribbling. Both patients went on to have curative surgical procedures. These cases reinforce the point that...

A 9-year-old girl presented with apparent meningococcal septicemia and developed acute renal failure after 48 hours of treatment with antibiotics and analgesics. Early ultrasound scanning demonstrated mild bilateral hydronephrosis and hydroureter. Intravenous urography showed slow contrast uptake with delay nephrogram and no contrast entering the b...

Objectives: Laparoscopic renal surgery has only recently become popular in the UK and, still, only a handful of pediatric urologists are offering the laparoscopic approach to their patients; therefore, there are only limited places available for training in this discipline. In this institution, which is a major tertiary referral center for pediatr...

We report two cases of vaginal bleeding in infants caused by endodermal sinus tumours of the vagina. The clinical features, diagnostic laboratory investigations and prognosis of this rare paediatric malignancy are discussed.

Between 1981 and 1993, 41 children were treated for hepatoblastoma. Clinical, radiological and pathological data were reviewed retrospectively, focusing on surgical aspects of treatment and outcome. Fourteen children underwent primary resection of the hepatic tumour. One infant with severe congenital anomalies received only palliative treatment. Of...