Background:
Technology has led to numerous changes in sacral neuromodulation (SNM) therapy, including the development of a minimally invasive procedure, tined lead, smaller implantable pulse generators (IPG), and different patient programmers. However, data derived from comparisons of different parameters of patient satisfaction are limited. 
Objective:
To assesse long-term satisfaction among patients who underwent SNM implantation.

We conducted a cross-sectional study with a designed survey sample questionnaire for all patients who had undergone SNM implantation and visited the urology clinic of Toronto Western Hospital between December 2011 and May 2012. The patients were asked to complete the questionnaire in the patient waiting area and hand it back to the secretary or to mail it within 2 weeks. The study was approved by the local medical ethics committee. The primary outcome analyzed by this study was patient satisfaction, which was subcategorized in the questionnaire into “very satisfied,” “moderately satisfied,” or “not satisfied.” Other questionnaire data used in the univariate analysis of satisfaction with SNM therapy were those pertaining to age, therapy indication and, duration of therapy, the need for combined medical therapy for symptom control, type of programmer used, and the patient’s ability to use it properly. Data were collected using Microsoft Excel 2003. Statistical analysis was performed using IBM SPSS 19.0. All the values were considered statistically significant at a p value

During the study period, 117 patients visited the clinic, of whom 71 completed the survey questionnaire with a response rate of 60.7%. The median age of the patients was 55 years (range, 26–84 years). The patients included 67 women (94.4%) and 4 men (5.6%). Of the patients, 41 (57.7%) had [overactive bladder] OAB; 15 (21.1%), chronic non-obstructive retention; and 15 (21.1%), frequency-urgency syndrome. The median duration of therapy was 2 years (range, 6 months to 15 years). Of the patients, 66 (93%) received unilateral SNM therapy and 5 (7%) received bilateral therapy. Forty-nine patients (69%) received SNM therapy alone, whereas 22 (31%) needed additional forms of therapy for symptom control (pain medication, 5 patients; clean intermittent catheterization, 2 patients; Botox, 2 patients; anticholinergics, 10 patients; and combined mediations, 3 patients). Fifty-nine (83.1%) did not develop any complications of SNM, and only 4 (5.6%) needed reoperation for IPG relocation and electrode revision. The type of patient programmer used was an old programmer in 10 patients (14.1%), a new programmer in 44 patients (62%), a twin programmer in 4 patients, and both an old and a new programmer in 5 patients. This information was missing for 8 patients (Table 1). The patient satisfaction level for SNM therapy was 95.8% (32 [45.1%], very satisfied and 36 [50.1%), moderately satisfied), but 3 patients (4.2%) were not satisfied. Satisfaction with SNM therapy correlated with the need for combined therapy for symptom control (correlation coefficient, 0.341; p = 0.004), but not with age, duration of therapy, complications, and programmer type. Regarding patient’s ability to use the programmer, 31 patients (43.7%) thought that it was easy to use, whereas 7 patients (9.9%) thought that it was difficult to use. Thirty-three patients (46.5%) did not comment on their ability to use the programmer. The type of programmer used did not show any relationship with patients’ ability to use the programmer (p = 0.97), nor did patient age (p = 0.765).

The satisfaction rate obtained in the present study was high at 95%, which is higher than the 90–84% satisfaction rate reported in previous studies. We think our rate is overestimated, as we obtained it from patients visiting at a specific time, exclusively from patients who underwent SNM implantation. To our knowledge, this is the first study on the effect of new technological developments on patient satisfaction. In our research, we found that the need for additional therapy for symptom control was the main factor that affected satisfaction significantly (correlation coefficient, 0.341; p = 0.004). The complication rate in the presented group was very low.
Other technical issues included the type of patient programmer. It had undergone many changes from a single large programmer to multiple small programmers, with the need for operative understanding, with all these types only 31 patients (43.7%) thought that it is easy to use, 7 patients reported difficult to use, and 33(46.5%) didn’t make any comment on their ability to use the programmer.

Conclusion:
Patients with SNM for voiding dysfunction have a high satisfaction rate with the therapy. Their satisfaction is mainly correlated to the need of additional medications for symptom control.