Niels Klarskov - Academia.edu (original) (raw)

Papers by Niels Klarskov

Trials, Mar 27, 2024

Background Approximately 85% of women experience an obstetric tear at delivery and up to 25% subs... more Background Approximately 85% of women experience an obstetric tear at delivery and up to 25% subsequently experience wound dehiscence and/or infection. Previous publications suggest that intravenous antibiotics administrated during delivery reduces this risk. We do not know if oral antibiotics given after delivery can reduce the risk of wound dehiscence or infection. Our aim is to investigate whether three doses of oral antibiotics (amoxicillin 500 mg/clavulanic acid 125 mg) given after delivery can reduce the risk of wound dehiscence and infection in patients with a second-degree obstetric tear or episiotomy. Methods We will perform a randomized, controlled, double-blinded study including 221women in each arm with allocation 1:1 in relation to the randomization. The study is carried out at

PubMed, May 3, 2023

Introduction: Acute kidney injury (AKI) is an abruptly occurring loss of renal function, which in... more Introduction: Acute kidney injury (AKI) is an abruptly occurring loss of renal function, which includes both kidney injury and kidney impairment. It is associated with mortality and morbidity due to the increased risk of developing chronic kidney disease. The aim of this systematic review and meta-analysis was to determine the incidence of post-operative AKI in gynaecological patients without pre-existing kidney injury. Methods: Systematic searches were made for studies examining the association between AKI and gynaecological surgery published between 2004 and March 2021. The primary outcome was to compare two subgroups of studies; a screening group where AKI was diagnosed by systematic clinical screening and a non-screening group where AKI was diagnosed randomly. Results: Among the 1,410 records screened, 23 studies met the inclusion criteria, reporting AKI in 224,713 patients. The pooled incidence for post-operative AKI after gynaecological surgery in the screening subgroup was 7% (95% confidence interval (CI): 0.04-0.12). The overall pooled result for post-operative AKI after gynaecological surgery in the non-screening subgroup was 0% (95% CI: 0.00-0.01). Conclusion: We found a 7% overall risk of post-operative AKI after gynaecological surgery. We found a higher incidence of AKI in the studies screening for kidney injury, illustrating that the condition is underdiagnosed when not screened for. An important risk exists of healthy women developing severe renal damage as AKI is a common post-operative complication with a potentially severe outcome that may be prevented in early diagnosis.

Neurourology and Urodynamics, 2019

Introduction and hypothesis The wide variety of suture material used in colporrhaphy shows a lack... more Introduction and hypothesis The wide variety of suture material used in colporrhaphy shows a lack of consensus on the optimal choice. The evidence guiding the choice of suture material is scant. The aim of this study was to investigate the effects of rapid versus slowly absorbable suture on risk of recurrence after native tissue anterior colporrhaphy. Methods This longitudinal cohort study was performed secondary to a previously published study on pelvic organ prolapse recurrence after the Manchester-Fothergill procedure versus vaginal hysterectomy. Data were collected from four Danish databases and corresponding electronic medical records. In this study, women having had anterior colporrhaphy performed were included. Suture materials were divided in three groups: rapid absorbable multifilament suture (RAMuS), rapid absorbable monofilament suture (RAMoS) and slowly absorbable monofilament suture (SAMoS). The main outcome was recurrence of prolapse in the anterior compartment. Results A total of 462 women were included in this study. No significant difference in recurrence was found among the three suture groups. However, a non-significant tendency towards a higher risk of recurrence in the RAMoS group [HR 2.14 (0.75-6.10) p = 0.16] compared to the RAMuS group was observed. Conclusion In this study, the use of rapid absorbable multifilament suture compared to slowly absorbable monofilament suture does not seem to lead to a higher risk of recurrence after anterior colporrhaphy.

International Urogynecology Journal, May 22, 2023

International Urogynecology Journal, Jun 17, 2023

Introduction and hypothesis We aimed to examine the risk of bleeding in female patients undergoin... more Introduction and hypothesis We aimed to examine the risk of bleeding in female patients undergoing intravesical onabotu-linumtoxinA (BTX-A) treatments and provide clinical recommendations for the perioperative management of patients on antithrombotic therapy prior to BTX-A treatments. Methods This was a retrospective cohort of Danish female patients, who had their first BTX-A treatment because of an overactive bladder at the

American Journal of Obstetrics and Gynecology, Mar 1, 2022

Gynecologists should be aware of the risks associated with hysterectomy, and alternative uterus-s... more Gynecologists should be aware of the risks associated with hysterectomy, and alternative uterus-sparing treatments should be considered when possible. Women should be informed about the risks before being offered hysterectomy.

American Journal of Obstetrics and Gynecology, Aug 1, 2023

CRC Press eBooks, May 15, 2023

International Urogynecology Journal, Feb 10, 2023

American Journal of Obstetrics and Gynecology, Dec 1, 2022

Hypothesis / aims of study The prediction of de novo stress urinary incontinence (SUI) after pelv... more Hypothesis / aims of study The prediction of de novo stress urinary incontinence (SUI) after pelvic organ prolapse (POP) surgery is an unsolved enigma. Urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism is deteriorated after anterior colporrhaphy; this is most likely the cause of postoperative SUI. The preoperative value of urethral pressure during straining is a predictor of the risk of postoperative SUI (1). Studies have shown similar prevalence of SUI in women with posterior POP, which is thought to compress the urethra (2). It is however unclear whether postoperative de novo SUI is as frequent in these women, as it is in women with anterior POP. As far as we know, there are no studies on how the urethral closure mechanism is affected by surgery for posterior POP. We sought to investigate the mechanism of continence in women with posterior POP before and after posterior colporrhaphy, by means of urethral pressure reflectometry. Study design, materials and methods This was a prospective, observational study where women with posterior POP ≥grade two, scheduled for posterior colporrhaphy, were recruited from our outpatient clinic. The women were excluded if they: had concomitant vaginal wall prolapse ≥grade two in the anterior compartment; had a history of previous POP-or SUI surgery or hysterectomy; used any medicine for urinary incontinence. All study participants gave their written consent. The women were examined twice; before and after posterior colporrhaphy. Visits included POP staging according to the Pelvic Organ Prolapse Quantification (POP-Q) system and UPR measurements, in a supine position.

International Urogynecology Journal, Nov 6, 2017

International Urogynecology Journal, Aug 24, 2022

International Urogynecology Journal, Jul 10, 2017

Introduction and hypothesis Studies have suggested that a posterior vaginal wall prolapse might c... more Introduction and hypothesis Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism deteriorates after anterior colporrhaphy; this could explain the occurrence of postoperative de novo SUI. We hypothesized that urethral pressure would also decrease after posterior colporrhaphy. Methods This was a prospective, observational study where women with posterior vaginal wall prolapse ≥stage II were examined before and after posterior colporrhaphy. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining, and standardized stress tests with 300 ml saline. The women filled out International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher's exact test, where appropriate; p values <0.05 were considered statistically significant. Results Eighteen women with posterior vaginal wall prolapse ≥stage II were recruited. One woman did not undergo surgery. There were no changes in urethral pressure at rest (p = 0.4), during squeezing (p = 0.2) or straining (p = 0.2), before and after surgery. The results of the stress tests and ICIQ-UI short forms were the same after surgery. Conclusions The urethral closure mechanism is not affected by posterior colporrhaphy. Our study does not support the theory that the posterior vaginal wall prolapse compresses the urethra and masks SUI.

British Journal of Surgery, Nov 6, 2012

Background: Anal acoustic reflectometry (AAR) is a reproducible technique providing a novel physi... more Background: Anal acoustic reflectometry (AAR) is a reproducible technique providing a novel physiological assessment of anal sphincter function. It may have advantages over conventional anal manometry. The aims of this study were to determine the ability of AAR and anal manometry to identify changes in anal sphincter function in patients with faecal incontinence (FI) and to relate these changes to the severity of FI. Methods: Women with FI underwent assessment with AAR and anal manometry. All patients completed the Vaizey FI questionnaire and were classified according to symptom type (urge, passive or mixed) and integrity of the anal sphincters. The ability of AAR and anal manometry to correlate with symptom severity was evaluated. AAR was compared with anal manometry in detecting differences in anal sphincter function between symptomatic subgroups, and patients with and without a sphincter defect. Results: One hundred women with FI were included in the study. The AAR variables opening pressure, opening elastance, closing elastance and squeeze opening pressure correlated with symptom severity, whereas the manometric measurements maximum resting pressure and maximum squeeze pressure did not. Unlike anal manometry, AAR was able to detect differences in anal sphincter function between different symptomatic subgroups, whereas anal manometry was not. An anal sphincter defect was not associated with a significant change in anal sphincter function determined by either AAR or anal manometry. Conclusion: In the assessment of women with FI, AAR variables correlated with symptom severity and could distinguish between different symptomatic subgroups. AAR may help to guide management in these patients. Surgical relevance Anal manometry is the most widely used test of anal sphincter function, but has significant limitations. Considerable overlap between the values of anal manometry in continent and incontinent subjects has been reported, making some specialists view the test as unhelpful. Anal acoustic reflectometry (AAR) is a new, reproducible and clinically reliable technique that provides a dynamic physiological assessment of anal sphincter function. In this study AAR variables correlated with symptom severity in faecal incontinence, whereas anal manometry did not. Differences in anal sphincter function between specific symptomatic subgroups were detectable using AAR but not anal manometry. Anal sphincter defects were not associated with a significant change in anal sphincter function determined by either AAR or anal manometry. AAR appears to be a useful test in the investigative assessment of women with faecal incontinence. AAR may help to guide management in patients with faecal incontinence.

Colorectal Disease, Jan 12, 2010

Objective Anal acoustic reflectometry (AAR) is a new technique that offers an assessment of anal... more Objective Anal acoustic reflectometry (AAR) is a new technique that offers an assessment of anal sphincter function by the measurement of additional parameters not available with conventional manometry. The aim of this study is to describe the technique, methodology and initial pilot study results.Method Wideband sounds (100 Hz to 16 kHz) are transmitted into a thin polyurethane bag placed within the anal canal. Calculation of cross‐sectional area from reflected sound waves, over a range of pressures (0–200 cm H2O) during inflation/deflation of the bag, results in five physiological parameters of anal canal function. Five patients [three continent (two female) and two incontinent (both female)] were assessed with AAR and anal manometry.Results Anal acoustic reflectometry parameters were reduced in incontinent when compared with continent patients. Resting Opening Pressures (cmH2O) were 27 and 16 in patients with faecal incontinence (FI) vs 44 and 72 in continent patients; Resting Opening Elastance (cmH2O/mm2) was 0.88 and 1.08 in FI patients vs 1.65 and 1.34 in continent patients. The Resting Opening Pressure of a similarly aged continent male (55 cmH2O) was greater than three of the females. During assessment of voluntary contraction (one FI female vs one continent female), Squeeze Opening Pressure (cmH2O) was 31 vs 100 and Elastance (cmH2O/mm2) 0.61 vs 2.07.Conclusion Anal acoustic reflectometry appears to be promising technique. Further work is in place to clarify whether it will be useful in clinical assessment of incontinent patients.