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      Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil

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          PURPOSE: The hypothesis of association between testicular torsion and hyperactive cremasteric reflex, worsened by cold weather, has not been proved. Thirteen studies in the literature evaluated this issue, with inconclusive results. The aim of the present study was to evaluate the seasonality of testicular torsion in a large subset of patients surgically treated in Brazil, and additionally to estimate the incidence of testicular torsion. MATERIALS AND METHODS: Brazilian Public Health System Database was assessed from 1992-2010 to evaluate hospital admissions associated with treatment of testicular torsion. Average monthly temperature between 1992-2010 was calculated for each region. RESULTS: We identified 21,289 hospital admissions for treatment of testicular torsion. There was a higher number of testicular torsions during colder months (p = 0.002). To estimate the incidence of testicular torsion, we have related our findings to data from the last Brazilian census (2010). In 2010, testicular torsion occurred in 1.4:100,000 men in Brazil. CONCLUSIONS:Testicular torsion occurred at an annual incidence of approximately 1.4:100,000 men in Brazil in 2010. Seasonal variations do occur, with a significant increase of events during winter. Our findings support the theory of etiological role of cold weather to the occurrence of testicular torsion. Strategies to prevent these events can be based on these findings.

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          Most cited references 21

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          Acute scrotum -etiology, clinical presentation and seasonal variation.

          The aim of the present study was to evaluate the etiology, history, physical examination findings, and seasonal variation of acute scrotal problems in children. A retrospective review of all boys, presenting with acute scrotum to the Pediatric Surgery Clinic of the University Hospital Heraklion between January 1989 and December 2006 was performed. A total of 140 boys presented with scrotal pain were included. Overall the commonest cause of acute scrotum was epididymo-orchitis (35%, 95%CI: 27%-43%), followed by torsion of appendages. In contrast the most common cause in boys of preschool age was spermatic cord torsion (P<0.020). All cases of spermatic cord torsion were characterized by severe testicular pain and an absent cremasteric reflex. The interval between pain initiation and presentation to our clinic was 11.4 hours (SD:3.07) when the testis was salvaged by detorsion, and 19.0 hours (SD:6.32) when the testis was removed. The difference between means was statistical significant (p<0.001). The incidence of torsion of appendages (p<0.036) and/or spermatic cord (p<0.047) was increased in winter. The absence of cremasteric reflex in association with testicular tenderness strongly suggests testicular torsion. The low temperatures during winter may account for the increased incidence of the torsion of both the spermatic cord torsion and the appendages.
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            Testicular torsion and low relative humidity in a tropical country.

             O Mabogunje (1986)
            One hundred and thirty one patients with testicular torsion were reviewed retrospectively to investigate the association of testicular torsion with air temperature and low relative humidity in Zaria, Nigeria. The incidence of testicular torsion was significantly increased during the harmattan season (November to February), when relative humidity is low and temperature decreased. Relative humidity was more closely correlated with the incidence of testicular torsion than was air temperature. Testicular torsion is a major contributor to male infertility in Zaria, and further study of its causes is required.
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              Association of cold weather with testicular torsion

               RB Shukla,  DG KELLY,  L Daly (1982)

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                International braz j urol
                Int. braz j urol.
                Sociedade Brasileira de Urologia (Rio de Janeiro )
                April 2012
                : 38
                : 2
                : 222-229
                [1 ] Faculdade de Medicina do ABC Brazil
                Product Information: website
                UROLOGY & NEPHROLOGY


                seasons, Brazil, male, child, climate, spermatic cord torsion, testis


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