INTRODUCTION AND HYPOTHESIS: Our objective was to compare risk of surgical revision after sacral neuromodulator lead migration based on the type of anchoring system. METHODS: We performed a retrospective cohort study of patients receiving sacral neuromodulation over 7 years. We compared surgical revision due to loss of efficacy accompanied by radiographic lead migration in fascial-anchored versus tined leads. RESULTS: Of 112 patients, 28 (25%) underwent fascial anchoring, and 84 (75%) received tined leads. Within 2 years of implantation, lead migration occurred in 26% of fascial and 10% of tined anchoring systems (RR, 2.25 (95% confidence interval, 0.85-5.93)). Patients with fascial anchors were followed for a longer period of time. Therefore, Kaplan-Meier curves were compared showing no difference in risk of lead migration (p = 0.09). Four of eight (50%) lead migrations in tined leads occurred within the first 3 months after implantation. CONCLUSIONS: Two years after sacral neuromodulator implantation, lead migration is similar between fascial-anchored and tined leads.