Comparison of Dismembered and Nondismembered Y-V Pyeloplasty in Patients with Primary Hydronephrosis

Primary hydronephrosis caused by ureteropelvic junction obstruction requires surgical reconstruction. Dismembered and nondismembered Y-V pyeloplasty remain common procedures, yet comparative outcome evidence remains limited. Objective: To compare clinical outcomes, functional recovery, and complication rates between dismembered pyeloplasty and nondismembered Y-V pyeloplasty among patients diagnosed with primary hydronephrosis. Methods: This comparative observational study was conducted at the Department of Pediatric Surgery, Rajshahi Medical College Hospital from January–December 2025. Eighty-seven patients with primary hydronephrosis were evaluated. Participants underwent either dismembered pyeloplasty (n=46) or nondismembered Y-V pyeloplasty (n=41). Outcomes included operative time, hospital stay, postoperative complications, anteroposterior pelvic diameter reduction, and improvement in split renal function measured through diuretic renography. Statistical analyses included independent t-test and chi-square testing. Results: The mean operative time was significantly longer in the dismembered group (118.6 ± 21.4 minutes) compared with the Y-V group (96.3 ± 18.7 minutes; p = 0.002). Postoperative hydronephrosis reduction averaged 64.2% ± 13.1 in dismembered repair versus 52.8% ± 14.6 in Y-V repair (p = 0.01). Split renal function improved by 12.4% ± 6.2 and 9.1% ± 5.8 respectively (p = 0.03). Overall surgical success reached 93.5% in dismembered cases compared with 85.4% in Y-V reconstruction. Complication rates were 8.7% and 14.6% respectively (p = 0.04). Mean hospital stay showed minimal variation (4.6 ± 1.2 vs 4.3 ± 1.1 days; p = 0.28). Multivariable regression demonstrated operative technique and baseline pelvic diameter as independent predictors of postoperative drainage improvement (β = 0.34, p < 0.01). Conclusion: Both techniques effectively treat primary hydronephrosis, but dismembered pyeloplasty demonstrates superior functional improvement and lower recurrence, despite longer operative time, suggesting selective preference in anatomically complex obstruction