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

Abstract

<h4>Introduction</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Discussion</h4>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.<h4>Level of evidence: 4</h4>