Dr. Portera is a Urogynecologist – a surgeon who specializes in the care of women with urinary and pelvic floor disorders. He has been successfully treating patients suffering from these conditions for over 20 years, and he performs a higher volume of mesh-sling surgeries than any other Doctor in the Mid-South.
The pelvic floor is comprised of a set of muscles, ligaments and connective tissue in the lowest part of the pelvis that provides support for a woman’s internal organs, including the bowel, bladder, uterus, vagina and rectum.
A pelvic floor disorder occurs when women have weakened pelvic muscles or tears in the connective tissue due to excessive strain on the pelvis due to childbirth, repeated strenuous activity, menopause, chronic disease, or pelvic surgery. Other factors that can weaken the pelvic floor include repetitive heavy lifting, tobacco use, and genetics.
Problems that arise from damage to the pelvic floor:
1. Incontinence: loss of bladder or bowel control, leakage of urine or feces.
2. Prolapse: descent of pelvic organs; a bulge and/or pressure; ‘dropped uterus, bladder, vagina or rectum.’
3. Emptying Disorders: difficulty urinating or moving bowels.
4. Pain: discomfort to the lower back, pelvis or bladder and/or urethra.
5. Overactive Bladder: frequent need to void, bladder pressure, urgency, urge incontinence (difficulty holding back urine when having the urge to urinate)
6. Fistulas: abnormal hole between the vagina and rectum (rectovaginal), vagina and urethra (urethrovaginal), or vagina and the bladder (vesicovaginal)
What Kind of Training Does Dr. Poretra Have?
After having completed medical school and a residency in Obstetrics and Gynecology and Urology, he became a specialistwith additional years of fellowship training and certification in Female Pelvic Medicine and Reconstructive Surgery. The training consisted of providing expertise in the evaluation, diagnosis, and treatment of conditions that affect the muscles and connective tissue of the female pelvic organs. Dr. Portera also remains constantly up to date on the latest research in the field pertaining to these conditions.
When Should I See Dr. Portera?
Although your primary care physician, OB/GYN, or urologist may have knowledge about these problems, Dr. Portera can offer additional expertise. You should see (or be referred to) him when you have problems of prolapse, and/or troublesome urinary or fecal incontinence or when your primary doctor recommends consultation.
Other conditions for which you or your doctor should arrange a consultation with him include: problems with emptying the bladder or rectum, pelvic pain or bladder pain, fistulas, and the need for special expertise in vaginal surgery.
Why are experience and volume of Mesh-Sling procedures performed by Dr. Portera so important? For patients? For referring physicians?
“These findings support the regulatory statements that suggest that patients should be counseled regarding serious complications that can occur with mesh-based procedures for SUI and that
surgeons should achieve expertise in their chosen procedure,” wrote Dr. Blayne Welk of the department of surgery and the department of epidemiology and biostatistics at Western University and St. Joseph’s Health Care, London (Ont.) and his associates.
The investigators performed a population-based retrospective cohort study to determine the incidence of surgical removal or revision after a mesh-sling procedure for SUI and to examine whether there are specific risk factors for mesh-related complications. They analyzed data for 59,887 women who underwent the procedure across Ontario during a 10-year period. Median follow-up was 4.4 years.
The procedures were performed by 1,068 surgeons: 293 urologists, 625 gynecologists, and 150 unspecified clinicians. Cases were classified according to whether the surgeon performed a high or low volume of mesh-sling procedures specifically for SUI. High volume was defined as a number at or above the 75th percentile for yearly volume in the province, or more than 16 procedures per year.
Overall, 1,307 women (2.2%) required mesh removal or revision a median of 1 year after the initial surgery. The cumulative incidence of the composite outcome of removal/revision of vaginal or urethral mesh, removal of a foreign body, endoscopic treatment of a urethral foreign body or mesh encrustation, uretrolysis, or repair of a urethrovaginal fistula was 3.29 at 10 years, Dr. Welk and his associates reported.
Surgical specialty had no significant effect on complication risk.
This incidence is consistent with previous report from HMOs in the United States and a meta-analysis of clinical trial results, the investigators noted patients of low-volume surgeons had a 37% higher relative risk of complications requiring reoperation than did patients of high-volume surgeons. In a further analysis of the data, patients of low-volume surgeons were significantly more likely to experience the composite outcome than were patients of high-volume surgeons (hazard ratio, 1.37), and, again, the difference between surgical specialties was nonsignificant.
About S. Gregory Portera, MD, FACOG
Dr. Portera graduated from the Tulane University School of Medicine in 1992. He works in Memphis, TN and specializes in Urogynecology and Gynecology. Dr. Portera is affiliated with Baptist Memorial Hospital Memphis and Methodist Le Bonheur Germantown.
Dr. Portera’s Experience: 24 years in practice
Specialties: Female Pelvic Medicine and Reconstructive Surgery, Urogynecoloy, and Gynecology
Dr. Portera’s Education & Training:
Medical School: Tulane University School of Medicine (1992)
Internship: University of Tennessee Health Science Center (1993)
Residency: University of Tennessee Health Science Center (1996)
Fellowship: Urogynecology & Pelvic Floor Reconstructive Surgery –
University of Tennessee Health Science Center (1998)
Clinical Faculty: Urogynecology and Gynecology – University of Tennessee Health Science Center
Fellowship: American Board of Obstetrics and Gynecology
Professional Memberships:
American College of Obstetrics and Gynecology
American Urological Society
Memphis Medical Association
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