Sacral neuromodulation (SNM) is a therapeutic option offered to patients with idiopathic overactive bladder (OAB) or non-obstructive urinary retention, as an alternative treatment for refractory medical management. It allows for electrical stimulation of inhibitory circuits that modulate the micturition reflex and improve lower urinary tract symptoms. Despite high efficacy and safety, explantation remains a challenge clinically as it is unknown which factors predict explantation. Herein, we sought to understand the factors influencing SNM explantation.
We conducted a long-term retrospective cohort study of 587 patients receiving SNM at one academic tertiary care center in Toronto, Ontario, performed by one surgeon.
The Kaplan-Meier analysis demonstrated explantation-free survival probabilities of 97% (95% CI 96%-99%) at 1 year, 92% (90%-95%) at 3 years, and 81% (77%-86%) at 5 years. We did not determine any variables independently associated with time nor risk of explantation. The most common indication for explantation was loss of efficacy (57.7%), followed by patient preference (16.7%) and pain (16.7%).
Explantation after SNM occurs in a minority of patients, and is largely attributable to a loss of sustained therapeutic efficacy over time.
Neurourology and urodynamics. 2026 Jul 09 [Epub ahead of print]
Carly Fiorido, Mario Henrique Bitar Siqueira, Mohammed Aldoukhi, Nojoud Alamri, Eviatar Fields, Naeem Bhojani, Bilal Chughtai, Omar Buksh, Sagi Shprits, Katherine Lajkosz, Dean Elterman
University Health Network, Toronto, Ontario, Canada., Department of Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada., Faculty of Medicine, McGill University, Montréal, Quebec, Canada., Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada., Plainview Hospital, Smith Institute of Urology, Northwell Health, Syosset, New York, USA., Department of Biostatistics, University Health Network, Toronto, Ontario, Canada.