Geoffrey Cundiff
University of British Columbia, Obstetrics and Gynecology, Faculty Member
- Dr. Geoffrey Cundiff is Professor and Head of the Department of Obstetrics and Gynaecology at the University of Briti... moreDr. Geoffrey Cundiff is Professor and Head of the Department of Obstetrics and Gynaecology at the University of British Columbia, the Regional Head of Obstetrics & Gynaecology and Physician Program Director for the Perinatal Program for Vancouver Coastal Health Authority. He was recently named the inaugural Dr. Victor Gomel Professor of Obstetrics & Gynaecology.
Dr Cundiff has broad-based research interests ranging from the epidemiology of pelvic floor disorders, to anatomy, to education, to the prevention of maternal obstetrical trauma. With more than 120 peer reviewed publications and 6 books, he is best known for outcomes research for pelvic floor disorders including, surgical and non-surgical treatments, and has led several multi-centered randomized trials. He has been a pioneer in advocating patient-based outcomes measures and has worked to develop and validate such measures. He is presently a research scientist at the Centre for Health Evaluation Outcomes Sciences and has active trials in reconstructive surgery and obstetrics.edit
To determine the efficacy of prophylactic nitrofurantoin in preventing bacteriuria after urodynamics and cystourethroscopy. We assumed that nitrofurantoin prophylaxis would decrease the rate of infection after urodynamics and... more
To determine the efficacy of prophylactic nitrofurantoin in preventing bacteriuria after urodynamics and cystourethroscopy. We assumed that nitrofurantoin prophylaxis would decrease the rate of infection after urodynamics and cystourethroscopy from 19% to 5%. All women presenting for urodynamics and cystourethroscopy during a 27-month period were offered enrollment, and 142 were randomly assigned to receive two doses of long-acting nitrofurantoin 100 mg (n = 74), or two doses of placebo (n = 68). Nitrofurantoin and placebo capsules were identical, and subjects and physicians were masked to group assignment. Differences were assessed using Student t test for continuous data and chi2 analysis for dichotomous data. There were no statistical differences in demographic characteristics or final diagnoses between groups. Seven women (5%) who had bacteriuria on initial urine culture were not included in the final analysis. The frequency of bacteriuria in the postinstrumentation urine cultures was 6% overall, 7% in the treatment group, and 5% in the controls, a nonsignificant difference ([relative risk] 1.49, [confidence interval] 0.37, 5.95). The power of the study was 33% to detect a significant difference. Bacteriuria after combined urodynamics and cystourethroscopy was not improved by a 1-day course of nitrofurantoin.
Research Interests: Treatment Outcome, Medicine, Humans, Placebo, Female, and 15 moreObstetrics Gynecology, Urodynamics, Antibiotic Prophylaxis, Urine, Randomized Trial, Aged, Middle Aged, Adult, Randomized Controlled Trial, Cystoscopy, Delayed-Action Preparations, Confidence Interval, Nitrofurantoin, Relative Risk, and Paediatrics and reproductive medicine
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This article provides a historical perspective on the evolution of theories regarding the pathophysiology of stress urinary incontinence (SUI). The progression of these theories has followed the development of the diagnostic technologies... more
This article provides a historical perspective on the evolution of theories regarding the pathophysiology of stress urinary incontinence (SUI). The progression of these theories has followed the development of the diagnostic technologies that have provided insight into different aspects of urethral dysfunction. The earliest theories tied SUI to anatomic failure of urethral support. Recognition that anatomic failure impacted the interplay of intra-abdominal pressure and the bladder and urethra led to theories focused on the dynamic interaction between the bladder and urethral pressures. Investigators then began to recognize the importance of urethral sphincteric dysfunction. More recently, investigators have attempted to combine the anatomic and functional etiologies into a consolidated theory. These efforts point to a multi-factorial etiology of SUI. Continuing research has provided new insight into the neurophysiology of urethral function, opening new avenues for tailoring therapy for SUI.
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Research Interests: Medicine, Urinary incontinence, Pelvic Organ Prolapse, Humans, Female, and 15 moreAged, Stress Testing, Middle Aged, Adult, Physical examination, Study design, Sensitivity and Specificity, Logistic Regression Model, Logistic Models, Positive predictive value, Urinary Bladder, Stress urinary incontinence, Negative predictive value, Residual Volume, and Paediatrics and reproductive medicine
Research Interests: Surgery, Medicine, Urinary incontinence, Pelvic Organ Prolapse, Humans, and 15 moreFemale, Incidence, Aged, Middle Aged, Urinary Tract, Adult, Urinary System, Study design, Cystoscopy, Uterine Prolapse, Fascia Lata, Intraoperative Period, Reconstructive Surgical Procedures, Intraoperative complications, and Paediatrics and reproductive medicine
Treatment of pelvic prolapse with uterine conservation using the sacral hysteropexy may be associated with less patient morbidity but has uncertain subjective and objective outcomes. We sought to compare abdominal sacral hysteropexy (ASH)... more
Treatment of pelvic prolapse with uterine conservation using the sacral hysteropexy may be associated with less patient morbidity but has uncertain subjective and objective outcomes. We sought to compare abdominal sacral hysteropexy (ASH) with sacral colpopexy/total abdominal hysterectomy (ASC/TAH). This is an ambispective (retrospective/prospective) cohort pilot study comparing ASH to ASC/TAH. The primary outcome was global impression of improvement. Secondary outcomes were based on validated quality-of-life questionnaires and surgical complications. Eighteen ASHs were compared to 9 ASC/TAHs after a mean follow-up of 19 months. Whereas subjective outcomes did not differ, anterior failure (55%) and subsequent uterine pathology (22%) were higher in the ASH cohort. Graft erosion occurred in 33% of the ASC/TAH group. The ASH offers advantages and disadvantages that warrant further investigation with a prospective study.
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In recent years, pelvic floor surgeons have increasingly repaired pelvic organ prolapse around an intact uterus. Uterine conservation and hysteropexy have been driven by patient preference, less risk of mesh erosion, shorter operative... more
In recent years, pelvic floor surgeons have increasingly repaired pelvic organ prolapse around an intact uterus. Uterine conservation and hysteropexy have been driven by patient preference, less risk of mesh erosion, shorter operative time, and decreased blood loss and postoperative pain. We present a case series of patients with cervical elongation after vaginal sacrospinous hysteropexy using polypropylene mesh arms, a novel technique developed by the senior author. We defined cervical elongation as greater than or equal to a two-fold increase in cervical length compared with preoperative measurements. Of the 8 patients who underwent this procedure, 5 (62.5 %) had cervical elongation during the first year postoperatively. In the most severe case, the cervix extended to 4 cm beyond the hymenal ring. Most of the patients were mildly symptomatic and chose expectant management. The cases are reviewed in detail. A brief literature review on cervical elongation is presented.
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STUDY OBJECTIVE The objective of our study is to provide a contemporary description of hysterectomy practice and temporal trends in Canada. DESIGN A national whole population retrospective analysis of data from the Canadian Institute for... more
STUDY OBJECTIVE The objective of our study is to provide a contemporary description of hysterectomy practice and temporal trends in Canada. DESIGN A national whole population retrospective analysis of data from the Canadian Institute for Health Information SETTING: Canada PATIENTS: All women who underwent hysterectomy for benign indication from 01/04/2007 to 31/03/2017 in Canada. INTERVENTIONS Hysterectomy MEASUREMENTS AND MAIN RESULTS: A total of 369,520 hysterectomies were performed in Canada during the ten-year period, during which hysterectomy rate decreased from 313 to 243/100,000 women. The proportion of abdominal hysterectomies decreased (59.5% to 36.9%); laparoscopic hysterectomies increased (10.8% to 38.6%); vaginal hysterectomies decreased (29.7% to 24.5%); while the national technicity index increased from 40.5% to 63.1% (p<0.001, all trends). Median length of stay decreased from 3 (interquartile range 2, 4) days to 2 (IQR 1, 3), and proportion of patients discharged within 24 hours increased from 2.1% to 7.2%. In year 2016/17, women age 40-49 years had significantly increased risk of abdominal hysterectomy compared with women undergoing hysterectomy in other age categories (p<0.001). Comparing women with menstrual bleeding disorders, women undergoing hysterectomy for endometriosis (adjusted relative risk 1.36, 95% confidence interval [1.28-1.44]), fibroids (aRR2.01, 95%CI[1.94-2.08]) were at increased risk of abdominal hysterectomy, while women undergoing hysterectomy for pelvic organ prolapse and pelvic pain (aRR1.47, 95%CI[1.41-1.53]) were at decreased risk. Using Ontario as the comparator, Nova Scotia (aRR 1.35, 95%CI[1.27-1.43]), New Brunswick (aRR1.25, 95%CI[1.18-1.32]), Manitoba (aRR1.35, 95%CI[1.28-1.43]) and Newfoundland (aRR1.18, 95%CI[1.10-1.27]), had significantly higher risks of abdominal hysterectomy; whereas Saskatchewan (aRR0.75, 95%CI[0.74-0.77]) and British Columbia (aRR0.86, 95%CI[0.85-0.88]) had significantly lower risks; while Prince Edward Island and Quebec and Alberta were not significantly different. CONCLUSION Minimally invasive hysterectomy for benign indication has increased significantly in Canada. The declining use of vaginal approaches and the variation between provinces are of concern and necessitate further study.
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Research Interests: Quality of life, Medicine, Distress, Urinary incontinence, Humans, and 14 moreClinical research, Female, Urogynecology, Obstetrics and gynecology, Middle Aged, Intraclass Correlation Coefficient, Questionnaires, Reproducibility of Results, Cross-Over Studies, Uterine Prolapse, Internet, Fecal Incontinence, Pelvic Floor, and Paediatrics and reproductive medicine
Research Interests: Treatment Outcome, Medicine, Humans, Placebo, Female, and 15 moreObstetrics Gynecology, Urodynamics, Antibiotic Prophylaxis, Urine, Randomized Trial, Aged, Middle Aged, Adult, Randomized Controlled Trial, Cystoscopy, Delayed-Action Preparations, Confidence Interval, Nitrofurantoin, Relative Risk, and Paediatrics and reproductive medicine
Research Interests: Quality of life, Treatment Outcome, Risk assessment, Medicine, Probability, and 15 morePelvic Organ Prolapse, Humans, Female, American, Gels, Aged, Middle Aged, Adult, Randomized Controlled Trial, Risk Assessment, prosthesis Design, Pessaries, Sickness Impact Profile, Paediatrics and reproductive medicine, and crossover study
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A biomechanical model of the female pelvic support system was developed to explore the contribution of pelvic floor muscle defect to the development of stress urinary incontinence (SUI). From a pool of 135 patients, clinical data of 26... more
A biomechanical model of the female pelvic support system was developed to explore the contribution of pelvic floor muscle defect to the development of stress urinary incontinence (SUI). From a pool of 135 patients, clinical data of 26 patients with pelvic muscular defect were used in modelling. The model was employed to estimate the parameters that describe the stiffness properties of the vaginal wall and ligament tissues for individual patients. The parameters were then implemented into the model to evaluate for each patient the impact of pelvic muscular defect on the vaginal apex support and the bladder neck support, a factor that relates to the onset of SUI. For the modelling analysis, the compromise of pelvic muscular support was demonstrated to contribute to vaginal apex prolapse and bladder neck prolapse, a condition commonly seen in SUI patients, while simulated conditions of restored muscular support were shown to help re-establish both vaginal apex and bladder neck supports. The findings illustrate the significance of pelvic muscle strength to vaginal support and urinary continence; therefore, the clinical recommendation of pelvic muscle strengthening, such as Kegel exercises, has been shown to be an effective treatment for patients with SUI symptoms.
Research Interests: Dentistry, Biomedical Engineering, Medicine, Muscle strength, Urinary incontinence, and 15 morePelvic Organ Prolapse, Humans, Female, Vagina, Aged, Middle Aged, Pelvis, Adult, Clinical Data, Support System, Biomechanical Phenomena, Urinary Bladder, Valsalva Maneuver, Stress urinary incontinence, and Pelvic Floor
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Our purpose was to characterize historic and clinical parameters in incontinent women to determine the predictive value for urodynamic diagnoses. The analysis includes 535 consecutive women with final diagnoses of genuine stress... more
Our purpose was to characterize historic and clinical parameters in incontinent women to determine the predictive value for urodynamic diagnoses. The analysis includes 535 consecutive women with final diagnoses of genuine stress incontinence, detrusor instability, or both. Evaluations included a standardized history, examination, urinary diary, quantitation test, and urodynamics. The analysis used one-way analysis of variance, chi 2 analysis with Yates&#39; correction, and Fisher&#39;s exact test. A total of 351 (66%) women were diagnosed with genuine stress incontinence, 102 (19%) with detrusor instability, and 82 (15%) with both. Half had symptoms of both stress incontinence and urge incontinence, of whom only 21% had both genuine stress incontinence and detrusor instability. Fewer than half of women diagnosed with genuine stress incontinence or detrusor instability had just symptoms of stress incontinence or urge incontinence, respectively. Evaluation of historic, examination, and urinary diary data for their influences on the predictive value of pure stress incontinence or urge incontinence revealed statistical differences for urethral hypermobility, estrogen deficiency, and incontinent episodes, yet they were not clinically practical predictors. Pure symptoms identify fewer than half of patients with pure genuine stress incontinence or detrusor instability; historic and clinical parameters do not improve the sensitivity of these symptoms.
Research Interests: Urology, Medicine, Clinical Practice, Urinary incontinence, Humans, and 15 moreSmoking, Female, Urodynamics, American, Aged, Middle Aged, Estrogens, Adult, Analysis of Variance, Retrospective Studies, Study design, Parity, Predictive value of tests, Paediatrics and reproductive medicine, and Urethra
Research Interests: Obstetrics, Surgery, Psychometrics, Quality of life, Treatment, and 15 moreMedicine, Urinary incontinence, Humans, Questionnaire, Female, Aged, Middle Aged, Questionnaires, Gynecology, Uterine Prolapse, Pessaries, Severity of Illness Index, Sickness Impact Profile, Pelvic Floor, and Paediatrics and reproductive medicine
Research Interests: Obstetrics, Medicine, Humans, Female, Obstetrics Gynecology, and 15 moreOrgasm, Regression Analysis, Risk factors, Middle Aged, Questionnaires, Gynecology, Adult, pelvic floor dysfunction, Risk Factors, Asymptomatic, Dyspareunia, Proportional Hazards Models, Libido, Pelvic Floor, and Paediatrics and reproductive medicine
Research Interests: Surgery, Medicine, Humans, Female, Incidence, and 13 moreAged, Middle Aged, Urinary Tract, Adult, Urinary System, Cystoscopy, Wounds and Injuries, Uterine Prolapse, Fascia Lata, Intraoperative Period, Reconstructive Surgical Procedures, Intraoperative complications, and Paediatrics and reproductive medicine
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Objective To characterize uroflowmetry parameters in women with pelvic organ prolapse (POP) and urinary incontinence (UI) and to assess the effects of clinical and urodynamic variables on these parameters.Patients and methods The study... more
Objective To characterize uroflowmetry parameters in women with pelvic organ prolapse (POP) and urinary incontinence (UI) and to assess the effects of clinical and urodynamic variables on these parameters.Patients and methods The study comprised 655 consecutive women who presented with UI or POP and who had interpretable uroflowmetry values. Normal uroflowmetry values were defined as a maximum flow (Qmax ) ≥15 mL/s, a mean flow (Qmean ) ≥10 mL/s, a post‐void residual volume (PVR) ≤100 mL and a continuous, single‐peak waveform. Parametric and non‐parametric analysis of variance and chi‐square analysis were used to compare differences between diagnostic groups. Multiple linear regression models were developed to evaluate factors considered to influence uroflowmetry.Results Of the 655 patients, 471 (72%) had UI of whom 16% had pure detrusor instability (DI), 69% pure genuine stress incontinence (GSI) and 15% with both, and 184 (28%) had POP, 26% of whom also had DI. Of all patients, 72% had normal uroflowmetry patterns, 13% had multiple peaks and 15% had patterns with interrupted flow; 56% had completely normal uroflowmetry. There were significant differences in uroflowmetry values between the POP and UI groups, with the former having a lower Qmax and Qmean (P&lt;0.001), larger PVRs (P&lt;0.001) and a lower percentage of totally normal uroflowmetry (33% and 64%, respectively, P&lt;0.001). Of patients with POP, 30% had a PVR &gt;100 mL. Because of the differences, the POP and UI groups were evaluated separately in the regression analysis. In both groups, the most important determinants of flow rate were the volume voided and pressure transmission ratio (PTR). However, when several factors (including age, voided volume, PTR and maximum detrusor pressure with flow and at Qmax ) were included in the model, they accounted for only 23–26% of the variability of flow in the patients with UI and 36–39% of the variability in patients with POP. The subsets of patients with pure DI in both the UI and POP groups had higher PVR volumes than the other subsets.Conclusions These results show that the positive correlation between flow rate and voided volume described in normal populations is also observed in women with UI and POP. However, most of the variability in urine flow was not attributable to factors such as age, voided volume and PTR, confirming the complexity of the micturition mechanism. Women with POP had more objective evidence of emptying‐phase dysfunction than women with UI, although most emptied their bladders efficiently. Finally, the results suggest that women with DI exhibit dysfunction of both inhibitory and facilitory detrusor control.
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Research Interests: Sexual Dysfunction, Medicine, Comorbidity, Humans, Female, and 15 moreOrgasm, Aged, Prevalence, Middle Aged, Adult, Retrospective Studies, pelvic floor dysfunction, Pelvic Floor Disorders, Sexual Function, Cross Sectional Studies, Fecal Incontinence, Psychology and Cognitive Sciences, Pelvic Floor, defecation, and Medical and Health Sciences
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To evaluate the safety of outpatient induction with dinoprostone insert in low-risk labour inductions for premature rupture of membranes or postdates gestation. This retrospective cohort study compared outpatient labour induction priming... more
To evaluate the safety of outpatient induction with dinoprostone insert in low-risk labour inductions for premature rupture of membranes or postdates gestation. This retrospective cohort study compared outpatient labour induction priming with inpatient induction in terms of neonatal safety, mode of delivery, and obstetrical parameters. The sample included all inductions for premature rupture of membranes or postdate gestation. The analysis used logistic regression. The statistical power of the sample was 80% to detect a difference of 5.6% for the composite neonatal safety outcome (5-minute Apgar score <7 and NICU admission for >12 hours or transfer to a level III nursery). Compared with the inpatient cohort (n = 568), the outpatient cohort (n = 611) included more postdate gestations (93% vs. 67%) with less cervical dilatation (0.5 cm vs. 1.0 cm) and larger infants (3705 g vs. 3551 g). There were no differences in measures of neonatal safety or mode of delivery. The outpatient ...
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Objectives Surgery for the correction of stress urinary incontinence is an elective procedure that can have a dramatic and positive impact on quality of life. Anti-incontinence procedures, like inguinal hernia repairs or... more
Objectives Surgery for the correction of stress urinary incontinence is an elective procedure that can have a dramatic and positive impact on quality of life. Anti-incontinence procedures, like inguinal hernia repairs or cholecystectomies, can be classified as high-volume/low-morbidity procedures. The performance of a standard set of perioperative tasks has been suggested as one way to optimize quality of care in elective high-volume/low-morbidity procedures. Our primary objective was to evaluate the performance of 5 perioperative tasks—(1) offering nonsurgical treatment, (2) performance of a standard preoperative prolapse examination, (3) cough stress test, (4) postvoid residual test, and (5) intraoperative cystoscopy for women undergoing surgery for stress urinary incontinence—compared among surgeons with and without board certification in female pelvic medicine and reconstructive surgery (FPMRS). Study Design This study was a retrospective chart review of anti-incontinence surgic...