Sacral neuromodulation (SNM) is an effective therapy for refractory lower urinary tract dysfunction (LUTD). With the recent emergence of novel SNM systems, understanding the differences in post-implantation care, particularly hospital follow-up visits, is crucial for optimizing patient management.
Whilst there is no apparent difference in the surgical technique or patient outcomes for the two most widely used SNM technologies in the U.K., a notable difference exists in the number of at-home programmes available to patients (Axonics = 2 programmes; Medtronic >7 programmes). The aim was to identify whether this difference in programming influenced the frequency and nature (telephone vs. face-toface) of follow-up appointments, which impose a significant time and economic burden to both the patient and the hospital.

A retrospective analysis was conducted on electronic medical records of patients who received SNM implants using either Axonics (Group A) or Medtronic (Group B) systems between 01.01.2019 until 31.12.2022. Data on hospital follow-up visits, including frequency, nature, clinical outcomes and patient-reported outcome measures were collected and analysed. Statistical analysis was performed to compare the differences between the two groups. Follow up appointment were performed both as face-to-face consultations and telephone appointments.

Thirty-two patients were included, with 50% receiving Axonics and 50% receiving Medtronic SNM systems. Patients in each group were matched for age (median 39,5 years R:21-76 vs 40,5 years R:25-68), gender (14 female; 2 male) and type of Lower urinary tract symptom (LUTS) [8 voiding; 8 storage]. 
Parametric and non-parametric tests were used to investigate the association of independent variables with the number of patient visits at 6 and 12 months. Comparison between the 2 groups was also performed. 
No significant difference was found in the number of hospital follow-up appointments between the two groups. The median number of follow-up appointments at 6 and 12 months was 2 and 3, respectively, for both groups. Telephone appointments comprising the majority. See table 1.

Table 1 Number of appointments required post SNM (Telephone and Face-to-face)
		                                       6 months	12 months
Axonics	         telephone	               21	               34
	               Face to face	               12	               19
Medtronic	telephone	               26                    40
	               Face to face           	7	               14

Patients completed ICIQ-OAB, USP, LARS, EQ5d and SF-Qualiveen questionnaires. Comparison between the 2 groups revealed no significant differences in USP, EQ5D and ICQ-OAB scores.
Patient-reported fears “smelling strongly of urine/ bladder problems worsening” (SF-Qualiveen fear subscore) related to increased number of appointments (p=0.040,rho=0.895).
Faecal urgency/incontinence (p=0.023, rho=-0.673) (high LARS score), correlated with fewer follow-up visits at 6 months.

Comparison between the two groups revealed a striking similarity in the number of hospital follow-up appointments, whether conducted over the phone or in person, irrespective of whether patients received Axonics or Medtronic implants. This finding challenges conventional assumptions, as one device offers significantly more "at-home" programming options. With the Axonics device only entering the UK market in 2017, our study's relatively short follow-up period highlights the need for further investigation into the long-term post-implantation care required for these two systems. This will help determine the cost-effectiveness of Axonics versus Medtronic SNM systems and will enable optimisation of healthcare resource allocation in SNM therapy for LUTD.

There is no difference in the number of follow up appointments between the different SNS neuromodulation devices, Axonics and Medtronics.  Further investigation into the long-term post-implantation care is required.