for re-tx was 24.0, 25.7, and 24.1 wks for cycles 1, 2, and 3 (too few pts had yet requested re-tx in cycles 4 and 5 for an accurate estimate). Large improvements from BL in HRQOL that exceeded the minimally important difference were seen following each onabotA tx. The most common AE in each tx cycle was uncomplicated urinary tract infection (26.9, 24.2, 24.5, 20.4, and 14.9%). The proportion of pts requiring CIC due to elevated PVR was 4.6, 4.1, 4.7, 5.3, and 2.1% in onabotA 100U cycles 1 through 5. No change in the AE profile was observed. CONCLUSIONS: Repeated onabotA tx in OAB pts with UI inadequately managed with ACHs showed sustained improvements in OAB symptoms, pt perception of improvement in their condition, and HRQOL. A consistent safety profile was also seen, with no new safety signals. Source of Funding: Allergan, Inc. 1368 SACRAL NERVE STIMULATION (SNS) FOR THE TREATMENT OF IDIOPATHIC REFRACTORY OVERACTIVE BLADDER: COST-EFFECTIVENESS COMPARED TO OPTIMAL MEDICAL THERAPY, BOTULINUM TOXIN A (BONT-A) AND PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) Julie Jenks, Rizwan Hamid, Julian Shah, Tamsin Greenwell, London, United Kingdom; Chris Betts, Salford, United Kingdom; Silke Walleser, Nataie Hallas, Tolochenaz, Switzerland; Jeremy Ockrim*, London, United Kingdom INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) efficacy for overactive bladder (OAB) has been widely demon- strated yet its cost-effectiveness is unknown. The cost-effectiveness of SNS in patients with refractory idiopathic OAB with urinary incontinence (OAB-wet) was compared to optimal medical therapy (OMT), Botulinum Toxin A (BoNT-A) and PTNS within the United Kingdom NHS perspec- tive. METHODS: A published Spanish Markov model was adapted to current UK practice based on existing data and clinical expert advice. Treatment success was defined as 50% improvement in OAB-wet symptoms. Health care resource use included pre-, peri-, and post- procedure assessments; procedures (device replacement every 4.5yrs); drugs; catheters; follow-ups and adverse events. Both SNS using testing with tined-lead (SNS-tined-lead) and PNE (SNS-PNE) were evaluated. Incremental-cost-effectiveness-ratios (ICER; costs per quality-adjusted-life-year) were calculated for SNS vs. OMT and vs. BoNT-A (10yrs), and SNS vs, PTNS (5yrs); with univariate sensitivity analyses. RESULTS: At 10 years, the cumulative costs of SNS-tined-lead, SNS-PNE, BoNT-A and OMT were £22,052, £19,952, £20,756, £11,918, respectively; PTNS 5-year cumulative costs were £17,915.The QALYs for SNS-tined-lead, SNS-PNE, BoNT-A and OMT were 6.82, 6.64, 6.35 and 5.45 (10 yrs), respectively, and 3.44 for PTNS (5 yrs). ICERs were £7,060 and £18,459 for SNS-tined-lead vs. BoNT-A, and vs. OMT (10 yrs), respectively; both SNS-tined-lead and SNS-PNE were dominant (less costly and more effective) to PTNS at 5 yrs, and to BoNT-A at 7 yrs. ICERs were most sensitive to BoNT-A efficacy and costs, but results were generally robust. CONCLUSIONS: SNS in patients with OAB-wet provides addi- tional quality of life improvement. Higher initial costs for SNS are offset by a reduction in follow-up costs over time. This produces ICERs that are clearly below the threshold generally considered for cost-effective- ness. SNS represents value for money compared to OMT, BoNT-A and PTNS as it provides additional value at a reduced or small incremental cost, depending on the test method used. Source of Funding: None 1369 SACRAL NERVE STIMULATION REVISION AND REMOVAL: PATIENT, DEVICE, OR DOCTOR? Raul Ordorica*, Paul Bradley, Mona McCullough, Tampa, FL INTRODUCTION AND OBJECTIVES: Sacral Nerve Stimula- tion (SNS) (Medtronics, Inc.) can provide long-term benefit in the treatment of urgency frequency (UF), urge incontinence (UI), and urinary retention (R). Despite encouraging results, implant revision and/or removal is not uncommon. To review single institution experi- ence regarding SNS revision and/or removal to determine to what extent therapy failure can be attributable to patient, clinician, or device factors. METHODS: Retrospective review over 10 years regarding the revision and/or removal of SNS completed implants. Rationale for removal, intra-operative findings including comparison of compound muscle action potential (CMAP) data from original implantation, and clinical outcomes were evaluated. CMAP of levator and bilateral feet plantar flexors were performed at initial implantation and at time of revision and/or removal. RESULTS: From a total of 276 implanted devices, 42 complete systems were removed (15%), 51 batteries were revised (18%), and 50 leads were revised (18%). Of 42 complete systems removed, 26 were due to therapy failure, 13 were for MRI, 5 for infection (2%), and 6 for symptom resolution (UF- 4, R - 2). While 3 resolved over time, the remaining 3 improved either following resection of their outlet (2 males) or with hysterectomy (1 female). Of the 51 batteries revised, 16 were due to fatigue, 18 due to discomfort, and 17 due to therapy failure, 12 of which requiring changing to a dual lead system. 50 leads were revised in 37 patients. Of 31 leads for which initial and revision CMAP data was available, only 9 were found to have decreased response to stimulation as measured by CMAP. 25 leads in total were found to be compromised, 16 of which achieved success with revision, 2 with dual lead stimulation. 23 leads were found to be intact by CMAP despite reported decreased therapeutic efficacy, with the system then ex- changed for another lead (15), or with another lead added for bilateral stimulation (8). 17/23 of these “intact” leads that underwent revision resulted in significant improvement with  50% benefit. CONCLUSIONS: Despite initial benefit, SNS revision and ex- plantation is not uncommon, although rarely for infection. MRI except for head remains contraindicated in the setting of SNS. Complete diagnoses and treatment for other reversible conditions prior to implan- tation is mandatory. While reduced afferent input (deduced from CMAP measured reduced efferent response) readily explains reduced SNS efficacy over time, the finding of the “intact” lead with reduced efficacy is more concerning and suggests a tachyphylaxis to therapy, which may be rescued with revision. Source of Funding: None 1370 TINED LEAD VERSUS PERCUTANEOUS NERVE EVALUATION FOR SACRAL NERVE STIMULATOR ASSESSMENT Julie Jenks*, Rizwan Hamid, Julian Shah, Tamsin Greenwell, Jeremy Ockrim, London, United Kingdom INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) is a two-stage procedure. The test phase can be performed as an office-based local anaesthetic percutaneous nerve evaluation (PNE) requiring second stage placement of a new (tined) lead, or by the initial implantation of a permanent tined lead under general anaesthesia. Preliminary data has suggested that overall success rates are higher with initial placement of the permanent tined lead than in staged PNE-SNS approach. We evaluated the outcomes of both techniques. METHODS: Seventy consecutive patients had either PNE (n=35) or tined lead (n=35) evaluation and conversion to a permanent SNS implant according to response. Primary outcomes were assessed using frequency-volume charts, pad testing, ICIQ/EQ5D questionnaires and pain scores. Success was considered as greater than 50% reduc- e560 THE JOURNAL OF UROLOGY Vol. 189, No. 4S, Supplement, Monday, May 6, 2013