Impact of new decrees on pelvic implant surgery in France: Results of a national survey among urologists and gynecologists.

INTRODUCTION

Recent decrees conditioning the placement of pelvic implants on a minimum annual activity threshold per institution have raised concerns. A survey was conducted among French urologists and gynecologists to assess their practices and perceptions of these measures.

METHODS

An online questionnaire was distributed via three scientific societies (AFU, CNGOF, SCGP) in May 2025. It covered four themes: respondents' characteristics, experience in pelviperineology, impact of the new decrees, and opinions on surgical thresholds. The response collection period was 21days, with a reminder after one week.

RESULTS

A total of 431 practitioners responded (60% urologists, 40% gynecologists; 64% male; 34% aged 41-50). The majority worked in private practices (52%) and were trained in pelviperineology (61%). Regarding activity, 67% and 66% exceeded the thresholds for incontinence and pelvic organ prolapse (POP), respectively, but 18% and 18% did not meet them. Most incontinence procedures involved mid-urethral slings; 51% of respondents used only TVT, and 29% only TOT. For POP, sacrocolpopexy was the sole procedure performed by 9% of gynecologists and 61% of urologists. Among the latter, 59% did not perform Richter sacrospinous ligament fixation (vs. 6% of gynecologists). The perceived impact of the decrees was significant: 53% of practitioners (including 67% of urologists) reported a desire to withdraw from the management of female incontinence, and 46% from POP (including 79% of urologists). If authorization were lost, 71% would stop implanting meshes and 60% would refer patients elsewhere. Only 32% believed the thresholds would improve patient care. For 61% of practitioners, they did not guarantee individual experience, and for 51%, they did not reflect quality of care. Most respondents considered a threshold of 10 annual procedures more appropriate for POP and incontinence, and 78% believed that validation of specialized training would be more relevant than activity thresholds (78% among urologists).

DISCUSSION: This survey highlights a real risk of practitioner disengagement, particularly among urologists, potentially detrimental to healthcare provision. Thresholds are perceived as inadequate, and recognition of individual competence appears preferable.