Revision and Explantation After Permanent Sacral Neuromodulation for Overactive Bladder: A Systematic Review and Meta-Analysis.

INTRODUCTION AND HYPOTHESIS: Revision and explantation after permanent sacral neuromodulation (SNM) for overactive bladder (OAB) are important but inconsistently reported. We estimated rates of revision and explantation after permanent implantable pulse generator (IPG) implantation and summarized reasons for each outcome. METHODS: This PROSPERO-registered review (CRD420261434099) searched PubMed, Embase, Web of Science, and CENTRAL until June 26, 2026. Eligible studies included adults with OAB undergoing SNM IPG implantation with extractable revision or explantation outcomes. Random-effects proportional meta-analysis estimated pooled proportions with 95% confidence intervals (CIs). Heterogeneity was assessed using I2; subgroup, meta-regression, leave-one-out, and small-study-effect analyses were performed. Risk of bias was assessed with the JBI tool. RESULTS: Twenty-seven studies included 3278 implanted patients. Revision analysis included 18 studies (1611 patients; 281 events): pooled proportion 12.6% (95% CI 7.4-20.7; I2 = 90.4%). Explantation analysis included 23 studies (2923 patients; 343 events): pooled proportion 10.8% (95% CI 8.0-14.3; I2 = 81.9%). Studies with >2-year follow-up had higher revision (20.52% vs 5.82%; p = 0.005) and explantation proportions (13.61% vs 8.00%; p = 0.050) than ≤2 years. Mixed-OAB cohorts had higher explantation than single-phenotype cohorts. Revision commonly resulted from lead-related problems, battery/end-of-life, and loss of efficacy, which was the leading reason for explantation. Estimates remained robust on sensitivity analysis, with no small-study effects by Peters tests. CONCLUSIONS: After permanent SNM for OAB, revision and explantation occur in a meaningful minority of patients and should be reported separately. Standardized time-to-event reporting is needed to improve counseling, device selection, and durability assessment.