Mountain States Urogynecology

Announcing Dr. Robert Hammer, MD, FACOG, Director of Mountain States Urogynecology West. This practice is located on the campus of Exempla Lutheran Medical Center.

Dr. Hammer is new to the Colorado area. Originally from New Jersey, he studied at Tufts University School of Medicine in Boston, MA. He began his professional career in Chicago, where he completed his residency in Obstetrics and Gynecology at Northwestern University.

After completing his fellowship training at the Mayo Clinic in Phoenix, AZ, he spent seven years on the faculty at Northwestern. Dr. Hammer is dedicated to creating a practice where women feel comfortable addressing their problems and is committed to offering proven treatment options – both non-surgical and surgical.

To read more about Dr. Hammer, click here.

Minimally-Invasive Slings for Stress Urinary Incontinence:
More Options Than Ever

Since Dr. Ulf Ulmsten and his colleagues in Scandinavia developed and popularized the highly effective tension-free vaginal tape (TVT, Gynecare) suburethral sling in the early 1990s, American surgeons have been a little more open to accepting new technology and techniques from our European colleagues. Case in point is the new trans-obturator slings. While the classic retropubic TVT has become and still remains the gold standard procedure for minimally invasive slings, the new transobturator slings provide a potentially safer and, in many patients, probably equally effective alternative to the classic TVT sling and therefore its use by gynecologists and urologists is growing quickly. With this new approach, whether using the “out to in” or “in to out” method, the ability to avoid the retropubic space while blindly passing the trocars may lower the (already small) risk of hematoma, bladder injury, and bowel injury. However, this new method now enters an area of the body we, as gynecologic surgeons, are not as familiar with as compared to the retropubic space of Retzius. It is therefore essential for the surgeon to not only familiarize himself or herself with the new procedure, but also the anatomy that is involved in the new procedure, namely the structures superficial and deep to the obturator foramen. Full newsletter...

The 2002 published results of the cancelled Women’s Health Initiative (WHI) trials resulted in the widespread discontinuation of hormone therapy (HT) by perimenopausal and menopausal women. The ensuing symptomatology--hot flushes, night sweats, sleep disturbances, and vaginal dryness--has turned attention toward alternatives to conventional HT. Proponents of custom-compounded HT claim fewer related side effects and better symptom relief than conventional HT, as the compounds used are “bioidentical” to a woman’s own (endogenous) hormones. Plant hormones, usually extracted from soy and yams, are synthetically converted to chemical replicas of hormones that naturally occur in a woman’s body. An individualized formulation is usually based upon a woman’s current hormone levels as determined by saliva testing. Saliva is said to contain only bioavailable hormones as opposed to serum, which may not distinguish between protein-bound (not bioavailable) and bioavailable hormones. Full newsletter...

As most practitioners are aware, there are several options for the treatment of prolapse. Because this is a life-impacting (and not a life-threatening) condition, one option for mild to moderate prolapse is observation. However, when the prolapse worsens or affects the quality of life of a woman, and a pessary is not desired, surgery may be the best option. Sadly, in the past almost one out of three surgeries performed for prolapse and incontinence have been for failed procedures. To decrease this failure rate in selected patients, many advances have been made in materials used for augmenting traditional or site-specific repairs to compensate for and replace a woman’s own poor quality (weakened) tissue. Full newsletter...