About

Cindy Louise Amundsen is the Roy T. Parker, M.D. Distinguished Professor of Obstetrics and Gynecology in the School of Medicine at Duke University. Her clinical and research work focuses on the treatment of urinary incontinence, pelvic organ prolapse, and other lower urinary tract symptoms. Her treatment approaches include minimally invasive neural modulation systems, botox therapy, nerve stimulation, and prolapse surgery. She has contributed to the evaluation of the urinary microbiome and its relation to recurrent urinary tract infections. Dr. Amundsen holds a medical degree from the University of Tennessee Health Science Center and has been actively involved in research and clinical practice since at least 2012. Her work has been recognized through various grants, and she has published extensively on topics related to urinary urgency, nocturia, and falls, among others. She is also involved in mentoring and training programs related to women's reproductive health and urology.

Research topics

• Biology
• Bioinformatics
• Medicine
• Molecular biology
• Endocrinology
• Computational biology
• Chemistry
• Chromatography
• Physiology
• Internal medicine
• Biochemistry
• Gynecology
• Genetics

Selected publications

• Apolipoprotein E Mimetic Peptide CN-105 and Postoperative Delirium in Older Patients

  JAMA Network Open · 2026-04-03

  articleOpen access

  Importance: The apolipoprotein E (APOE) gene ε4 allele leads to increased Alzheimer disease risk and neuroinflammation and is also believed to play a role in postoperative delirium. However, the safety and feasibility of modulating apoE protein signaling to reduce postoperative neuroinflammation and delirium in older adults are unclear. Objective: To assess the safety and feasibility of the apoE mimetic peptide CN-105 for reducing delirium incidence and severity and neuroinflammation after noncardiac or nonintracranial surgery in older adults. Design, Setting, and Participants: This triple-blind, escalating dose, phase 2 randomized clinical trial enrolled patients from April 17, 2019, to December 28, 2022, at a tertiary academic medical center. Included patients were 60 years or older and scheduled for a noncardiac or nonintracranial surgery. Exclusion criteria were incarceration, planned chemotherapy within 6 weeks after surgery, or inability to undergo lumbar punctures. Data analyses were based on a modified intention-to-treat approach and were performed from August 14, 2023, to August 22, 2025. Interventions: Patients were randomly assigned 3:1 to the CN-105 group or placebo group. The CN-105 group received intravenous CN-105 doses of 0.1, 0.5, or 1 mg/kg starting within 1 hour before surgery and administered every 6 hours afterward until hospital discharge or 13 doses were received. Patients in the placebo group followed the same administration schedule. Main Outcomes and Measures: The primary outcome was safety-the incidence and number of postoperative adverse events (AEs). Secondary outcomes included feasibility (rate of drug doses administered within 90 minutes of schedule), postoperative delirium incidence and severity, and postoperative changes in cerebrospinal fluid (CSF) cytokine levels (interleukin [IL] 6, granulocyte-colony stimulating factor [G-CSF], monocyte chemoattractant protein-1 [MCP-1], and IL-8). Results: Among 203 enrolled patients, 186 (mean [SD] age, 68.7 [5.2] years; 119 males [64.0%]) were randomized (137 to the CN-105 group, 49 to the placebo group) and underwent surgery. The rates of grade 2 or higher AEs among patients in the CN-105 and placebo groups were 76.6% and 87.8% (relative risk [RR], 0.87; 95% CI, 0.76-1.00; P = .10). The CN-105 vs placebo group had fewer grade 2 or higher AEs per patient (median [IQR], 1 [1-3] vs 2 [1-5]; P = .03). The percentage of CN-105 doses administered within the time window was 94.6% (860 of 909; 95% CI, 92.9%-96.0%) in the CN-105 group and 93.8% (346 of 369; 95% CI, 90.8%-96.0%) in the placebo group. Among patients in the CN-105 vs placebo group, the postoperative delirium incidence was 19.3% vs 26.5% (odds ratio [OR], 0.66; 95% CI, 0.31-1.42; P = .29); the median (IQR) postoperative delirium severity scores were 1 (1-2) vs 2 (1-2) (P = .19); and the median difference in preoperative to 24-hour postoperative CSF cytokine-level changes were as follows: -0.39 pg/mL (95% CI, -0.93 to 0.14 pg/mL, P = .12) for IL-6, -0.84 pg/mL (95% CI, -3.06 to 1.40 pg/mL; P = .18) for G-CSF,-23.32 pg/mL (95% CI, -94.36 to 44.93 pg/mL; P = .57) for IL-8, and -2.36 pg/mL (95% CI, -58.57 to 58.62 pg/mL; P = .50) for MCP-1. Conclusions and Relevance: In this phase 2 randomized clinical trial of older surgical patients, CN-105 (vs placebo) administration was feasible and did not increase AEs. A phase 3 trial is warranted to further evaluate the efficacy of CN-105 for reducing postoperative AEs and to more precisely determine its effects on postoperative delirium incidence and severity. Trial Registration: ClinicalTrials.gov Identifier: NCT03802396.

  PublisherOA PDFDOI

• PD31-07 IS WEEKLY TEXT MESSAGING A RELIABLE METHOD TO ASSESS SYMPTOM AND TREATMENT CHANGES IN THE SYMPTOMS OF LOWER URINARY TRACT DYSFUNCTION RESEARCH NETWORK (LURN) URGENCY COHORT?

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• 64 - Lower Urinary Tract Symptom Severity is Associated with Poor Physical Function in Care-Seeking Women Compared to Men

  Continence · 2025-01-01

  articleOpen access

  Figure 1. Table 1. Figure 2. Table 2.

  PublisherDOI

• Midurethral Sling vs OnabotulinumtoxinA in Females With Urinary Incontinence

  JAMA · 2025-05-05 · 7 citations

  letterOpen access

  Importance: Mixed urinary incontinence, which includes both stress and urgency urinary incontinence, adversely affects quality of life and can be difficult to manage. Studies comparing procedural-based treatments for mixed urinary incontinence are lacking. Objective: To determine whether intradetrusor onabotulinumtoxinA is more effective than midurethral sling for the treatment of mixed urinary incontinence in females. Design, Setting, and Participants: Randomized, superiority trial involving females (aged ≥21 years) with moderate to severe bother from both stress and urgency urinary incontinence who had unsuccessful conservative treatments and oral medications. The study was conducted at 7 US sites with enrollment between July 2020 and September 2022; the last date of follow-up was December 29, 2023. Interventions: Intradetrusor injection of onabotulinumtoxinA, 100 U (treatment focused on the urgency component), vs surgical synthetic mesh midurethral sling (treatment focused on the stress component). Recipients of onabotulinumtoxinA could receive an additional injection between 3 and 6 months. All participants could receive additional treatment (including crossover to the alternative treatment) between 6 and 12 months. Main Outcomes and Measures: The primary outcome was change at 6 months in mixed incontinence symptoms as measured by the Urogenital Distress Inventory (UDI) total score (0-300 points; higher scores indicate worse symptoms; minimal clinically important difference, 26.1). Secondary outcomes included stress and irritative UDI subscores. Results: Among 150 females randomized, 137 were treated, had postbaseline outcome data, and were included in the primary analysis (mean [SD] age, 59.0 [11.5] years). Both groups demonstrated mean improvement in UDI total score at 6 months with no significant difference between groups (onabotulinumtoxinA: -66.8 points [95% CI, -84.9 to -48.8]; sling: -84.9 [95% CI, -100.5 to -69.3]; mean difference, 18.1 points [95% CI, -4.6 to 40.7]; P = .12). For secondary outcomes, greater UDI stress score improvement was seen with the sling (-45.2 [95% CI, -53.7 to -36.8]) compared with onabotulinumtoxinA (-25.1 [95% CI, -34.1 to -16.1]) (P < .001); however, no significant difference was seen between groups in UDI irritative score (onabotulinumtoxinA: -32.9 [95% CI, -40.3 to -25.6] vs sling: -27.4 [95% CI, -34.6 to -20.3]; P = .27). In the onabotulinumtoxinA group, 12.7% and 28.2% received a second injection by 6 and 12 months, respectively. By 12 months, 30.3% in the sling group received onabotulinumtoxinA, and 15.5% in the onabotulinumtoxinA group received a sling. Overall, adverse events were not different between groups. Conclusions and Relevance: There was no observed difference in UDI total score improvement at 6 months between the onabotulinumtoxinA and midurethral sling groups in females with moderate to severe mixed urinary incontinence who previously did not respond to conservative treatments. These findings may help inform treatment decisions based on patient preference in partnership with clinician recommendations. Trial Registration: ClinicalTrials.gov Identifier: NCT04171531.

  PublisherOA PDFDOI

• 142 - Treatment Settings for Implantable Tibial Neuromodulation (iTNM): Programming Experience from the First Year of the OASIS Study

  Continence · 2025-01-01

  articleOpen access

  Figure 1. Revi Programming Algorithm Figure 2. Distribution of Frequency (A) and Pulse Width (B) Over Initial 12 Months of Follow-up

  PublisherDOI

• MP30-11 PATIENTS WITH URINARY URGENCY HAVE MORE CENTRAL SENSITIZATION SYMPTOMS AND GENERALIZED SENSORY SENSITIVITY THAN CONTROLS – A SYMPTOMS OF LOWER URINARY TRACT DYSFUNCTION RESEARCH NETWORK (LURN II) STUDY

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• MP30-04 EXPECTATIONS OF TREATMENT FOR URINARY URGENCY: A MIXED METHODS INVESTIGATION IN THE SYMPTOMS OF LOWER URINARY TRACT DYSFUNCTION RESEARCH NETWORK (LURN II)

  The Journal of Urology · 2025-04-08

  article
  PublisherDOI

• 140 - Impact of Implantable Tibial Neuromodulation (iTNM) Using the Revi System in Women with Urgency Predominant Mixed Urinary Incontinence

  Continence · 2025-01-01

  articleOpen access

  Figure 1. Table 1: Baseline Characteristics Figure 2. Table 2: Voiding Diary and Quality-of-Life Outcome Measures

  PublisherDOI

• Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN II) Urinary Urgency Phenotyping Study: Methods and Baseline Urinary Symptoms by Age and Sex

  Neurourology and Urodynamics · 2025-04-24 · 4 citations

  articleOpen access

  AIMS: To present the methods and baseline findings from a prospective, longitudinal cohort study of treatment seeking adults with urinary urgency (URG) with or without urgency urinary incontinence (UUI). METHODS: Adults seeking treatment for URG and/or UUI and controls were enrolled. Participants completed physical examination, urine and serum studies, post-void residual, and validated questionnaires. RESULTS: Data from 809 participants were analyzed. Cases and controls were both predominantly white. The mean overall age of the cases was older (62 vs. 59 years) as was the mean BMI and functional comorbidity index scores. Higher proportions of controls were never smokers. Among cases, bivariate analysis found higher proportions of women reporting URG, URG with fear of leaking, any UI and UUI. Men had higher proportions of often or almost always reporting nocturia. Higher proportions of men reported URG alone and UUI without stress UI. Mixed UI was prevalent among women but rare among men. In logistic regression models, women had higher odds of SUI, UUI, and dysuria compared to men. Men had higher odds of nocturia, intermittency, splitting/spraying, and hesitancy. Older participants had higher odds of UUI, nocturia, any UI, and URG with fear of leakage whereas younger participants had higher odds of stress UI, irritative symptoms. CONCLUSION: Treatment-seeking adults with URG and/or UUI were older, had higher BMI, worse functional comorbidity index and higher proportions of prior smoking history compared to controls. Among cases, sex and age differences were seen in within the spectrum of URG and UUI.

  PublisherOA PDFDOI

• Outcomes by frailty and mobility in older patients undergoing major urogynecologic surgery: a planned supplementary study of the apical suspension repair for vault prolapse in a three-arm randomized (ASPIRe) trial

  American Journal of Obstetrics and Gynecology · 2025-11-08

  articleOpen access
  PublisherOA PDFDOI

Recent grants

• Duke KURe Program

  NIH · $7.7M · 2013–2028

• Advancing the Measurement and Classification of Lower Urinary Tract Dysfunction

  NIH · $5.3M · 2025–2026

Frequent coauthors

• J. Eric Jelovsek

  Duke University

  312 shared

• Christopher Chermansky

  University of Pittsburgh

  303 shared

• Holly E. Richter

  University of Alabama at Birmingham

  167 shared

• Donna Mazloomdoost

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  166 shared

• Vivian W. Sung

  Brown University

  165 shared

• Deborah L. Myers

  165 shared

• Yuko M. Komesu

  University of New Mexico

  161 shared

• W. Thomas Gregory

  Island Institute

  159 shared

Awards & honors

• Eunice Kennedy Shriver National Institute of Child Health an…
• Eunice Kennedy Shriver National Institute of Child Health an…
• National Institute of Diabetes and Digestive and Kidney Dise…