Sacral neuromodulation (SNM) is a well-established third-line therapy for overactive bladder and urge urinary incontinence. Although SNM has been available since the late 1990s, access to this therapy remains uneven across the globe. The Arab world has seen recent advancements in surgical techniques and medical technologies. However, access to SNM continues to be limited in many of these nations.
The primary objective of this study is to evaluate the utilization of SNM across the Arab world in comparison to neighboring regions, including Sub-Saharan Africa and Turkey . Our findings may help guide future efforts to improve access and service distribution

Leading SNM device suppliers were contacted to provide data on the availability of SNM services between 2021 and 2024 across the Arab world, Sub-Saharan Africa, Eastern Europe, and Turkey. We compared implantation rates adjusted for both population size (based on the World Bank, 2023 data) and OAB prevalence in countries where SNM services are available, according to recent publications. The estimated number of OAB patients was calculated based on the population aged >20 years and previously reported prevalence in these populations. SNM utilization was then calculated as implants per 100,000 individuals with OAB, allowing for equitable cross-regional comparisons.

SNM implantation data from 2021 to 2024 were obtained from Medtronic, the primary provider of SNM devices in these regions. Although another major supplier, Axonics, was contacted, they reported no active services in the specified areas.
SNM services were available only in 3 of the Gulf countries out of 22 Arab countries. The growth of SNM services in these countries showed continuous improvement from 2021 to 2024. However, low implantation rates were observed compared to the large estimated population with OAB. When compared to other regions, higher implantation rates were found in South Africa, while the implantation rates in the three Arab countries with SNM services were comparable to those in Turkey.

The findings indicate that the availability and utilization of SNM devices in the Arab world remain relatively low compared to other regions, and to the estimated number of OAB population, despite the recent growth in the number of SNM implants in the Gulf countries (Saudi Arabia, UAE, and Kuwait). 
Furthermore, the presence of SNM services in only 3 out of 22 Arab countries underscores the significant need to expand access to this therapy for patient populations across the region.
South Africa demonstrated the highest rate of SNM implantations, which offer valuable lessons in terms of service provision and potential improvements for the Arab world.  

Our study was limited by the lack of clinical data regarding the specific diagnoses of patients who received SNM implants across different countries. The only available source for estimating procedure volumes was implant data provided by the device supplier. Additionally, estimating the number of patients eligible for SNM therapy posed a challenge due to variability in population data and OAB prevalence rates. Nevertheless, the stark contrast between the number of implants performed and the limited number of countries offering SNM services reinforces the validity of our findings

The results of this study highlight significant regional disparities in the availability and utilization of SNM therapy. While there is promising growth in the Gulf countries, the relatively low implantation rates suggest that there are barriers to widespread adoption, including awareness, healthcare infrastructure, and financial constraints. Further research into the factors influencing SNM adoption in these regions—such as healthcare policies, patient education, and availability of trained professionals—is necessary to optimize SNM service delivery across the Arab world and other underserved regions.