Rechargeable vs Recharge-Free Sacral Neuromodulation: Patient Preferences and Satisfaction

Objectives: The rechargeable generator for sacral neuromodulation (SNM) therapy was introduced in 2019. Patient perceptions and experiences with rechargeable versus the traditional recharge-free generators for SNM are poorly understood and under-researched. We aimed to compare patient perceptions in different domains of therapy in rechargeable versus recharge-free SNMs.

Methods: A cohort study was performed at one academic health system from 1/2022 through 8/2022. Patients who had undergone a SNM procedure with a urogynecologist between 1/2010 and 6/2021 were identified by electronic medical record (EMR) review via CPT code search and verified by implant procedures record crossmatching. Demographics, clinical history, and therapeutic course were extracted from the EMR. Patients were contacted and asked to complete via phone/email a 22 item questionnaire evaluating battery fit, battery recharging, programmer function, training, overall satisfaction, device removal, and reasons for generator selection. A patient satisfaction composite score of ≥ 75 defined high therapy satisfaction.

Results: 104 female patients were identified and 53 (51%) submitted responses - 43 (81%) recharge-free and 10 (19%) rechargeable. No significant differences in baseline demographics between cohorts were found except for a higher proportion of white patients in the rechargeable cohort (80% vs 49%, p = 0.009). Compared to patients with recharge-free generators, patients with rechargeable generators were more likely to have had prior SNM therapy (50% vs 9%, p < 0.01), had higher but not statistically different composite satisfaction scores (64 ± 26 rechargeable vs 58 ± 34 recharge-free, p = 0.65), and had higher programmer satisfaction composite scores (76 ± 26 rechargeable vs 49 ± 31 recharge-free, p < 0.01). There were fewer device removals in patients who met the threshold for high therapy satisfaction (1 vs 7, p < 0.02). Of the patients with recharge-free generators, 23 (53%) cited physician recommendation as their reason for choosing their type of generator.

Conclusions: Compared to patients with recharge-free SNM generators, patients with rechargeable SNM generators demonstrated higher programmer satisfaction and a trend towards higher therapy satisfaction. Physicians have an outsized influence on patients' choice of therapy, and further research assessing physician perspectives can elucidate any biases that may influence patient counseling.