Direct Full-stage Implantation of Sacral Neuromodulation

Inclusion Criteria: * Patients \>18 years of age * Female gender * Refractory overactive bladder: wet failing treatment with two or more anticholinergic and/or beta-3 agonist agents * Willing to stop treatment with anticholingeric and/or beta-3 agonist agents during the study period (2 week washout period preoperatively and 6 months postoperative) * Willing and able to complete study questionnaires, use Medtronic device programmer, return for scheduled follow-up appointments * Surgical candidate able to hold antiplatelet or anticoagulation prior to surgery * Health insurance provider that will cover full-stage implantation Exclusion Criteria: * Age \<18 * Pregnant or planning to become pregnant * Male gender * Unable or unwilling to stop anticholingeric and/or beta-3 agonist agents during the study period * Treatment with botulinum toxin within last 6 months * Recent surgery for stress urinary incontinence or pelvic organ prolapse within last 6 months * Severe pelvic organ prolapse * Post-void residual \>150 ml * Symptomatic or recurrent urinary tract infection * Neurologic disorders: cerebrovascular accident with neurologic deficits, Parkinson's, multiple sclerosis, spinal cord injury, significant peripheral neuropathy * Cognitive disorders, e.g. dementia * Interstitial cystitis or chronic pelvic pain syndrome * Poorly controlled diabetes mellitus (HbA1c \>10%) * History of bladder malignancy, pelvic radiation, urinary retention requiring catheterization * Anticipated or known need for MRI at the trunk * History of or anticipated surgery at the lower back * Unable to hold antiplatelet or anticoagulation prior to surgery * Life expectancy \<1 year