Sacral neuromodulation (SNM) is an established treatment for refractory urinary incontinence and voiding dysfunction, demonstrating significant improvements in symptoms and quality of life (1,2). However, in publicly funded healthcare systems, access to SNM can be delayed due to systemic limitations, yet the impact of these delays remains underreported. We aim to present our initial experience and clinical outcomes of patients undergoing SNM at a tertiary care public hospital, highlighting key challenges and early insights. To the authors’ knowledge, no previous studies have directly examined the burden of wait times for SNM in a public setting, particularly for female patients, which will be the key emphasis of this study.

This case series evaluates SNM procedures performed at a large tertiary care public hospital, with a primary focus on the time from referral to first-stage SNM surgery and the proportion of patients achieving full implantation. A total of 12 patients were included, of whom 10 were female  and 2 were male. Data collected included demographics, voiding parameters, implantation outcomes, and surgical complications. Patients underwent an initial one week of trial of implant with a clinic review to assess symptom improvement .A successful trial is defined as a >50% improvement in symptoms, which are usually episodes of urinary incontinence or frequency of self catheterisation. All patients undergo a 1-2 week trial prior to a full implant.

Four patients (33.3%) proceeded to successful full SNM implantation, all of whom were female (Table 1). Among female patients, 75.0% did not progress beyond the test phase. No male patients achieved full implantation. The average time from referral to initial SNM surgery was 196.25 days (SD = 147.95), highlighting significant access delays (Table 2). Patients who successfully underwent implantation were older (M = 63.5 years, SD = 11.15) than those who did not (M = 50.13 years, SD = 16.99). Voided volumes were also lower in the successful group (M = 117.33 mL, SD = 58.05) compared to the unsuccessful group (M = 270.71 mL, SD = 168.66). Mean referral-to-surgery times were slightly shorter in the successful group (184.75 days) than the unsuccessful group (202.00 days), although both groups experienced substantial delays. Only one patient had minor post op complication which required antibiotic.

Our results indicate an average wait time of over six months for initial SNM lead evaluation. Additionally, older age and lower voided volume were associated with more favourable outcomes.

Patients suffering from refractory incontinence often already endure a markedly reduced quality of life. The prolonged wait times for SNM in the public healthcare system further exacerbate their physical, emotional, and social burdens. Despite being eligible for advanced intervention, patients in this cohort waited an average of over six months for initial surgery as per our findings from this case series. Older age and lower voided volume were associated with more favorable outcomes, but long delays may compromise timely symptom relief and overall treatment success. These findings underscore the urgent need for system-level strategies to improve access, reduce wait times, and prioritize care for this vulnerable patient population.

Amundsen CL, et al. (2016). Sacral neuromodulation vs onabotulinumtoxinA for refractory urgency urinary incontinence. JAMA, 316(13), 1366–1374.
Hassouna, M M et al. “Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety.” The Journal of urology vol. 163,6 (2000): 1849-54.