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      Cold weather is a predisposing factor for testicular torsion in a tropical country. A retrospective study : Clima frio é um fator predisponente para torção testicular num país tropical. Um estudo retrospectivo

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          ABSTRACT

          CONTEXT AND OBJECTIVE:

          Testicular torsion is a medical and urological emergency because it can lead to loss of the organ. The theory of seasonal testicular torsion occurrence is based on studies from institutions located in cold and temperate regions. The objective here was to determine whether cold weather is associated with higher incidence of testicular torsion in a tropical country, such as Brazil.

          DESIGN AND SETTING:

          Retrospective study, conducted in a tertiary and teaching hospital.

          METHODS:

          Patients with acute testicular torsion confirmed by surgery between April 2006 and March 2011 were studied. Information on weather conditions at the time of symptom onset was collected.

          RESULTS:

          A total of 64 testicular torsion cases were identified. The months with the highest incidences of testicular torsion were June (16%), July (19%) and August (11%), which had the lowest mean temperatures, of 17.6 °C, 16.4 °C and 18.2 °C, respectively. Eleven percent of cases occurred during spring (October to December), 16% occurred in summer (January to March), 34% occurred in fall (April to June) and 39% occurred in winter (July to September). There was a significant association between the incidence of testicular torsion and the season (fall and winter), P < 0.001.

          CONCLUSIONS:

          Testicular torsion follows a seasonal association even in a tropical country, and is more frequent in the colder months of the year, namely fall and winter, when almost three-quarters of the cases occurred. These observations add further evidence that cold weather has an etiologic role in testicular torsion occurrence.

          RESUMO

          CONTEXTO E OBJETIVO:

          A torção testicular é uma emergência médica e urológica, pois pode levar à perda do órgão. A teoria da ocorrência sazonal da torção testicular é baseada em estudos de instituições localizadas em regiões frias e temperadas. O objetivo foi determinar se o clima frio está associado a uma maior incidência de torção testicular em um país tropical, como o Brasil.

          TIPO DE ESTUDO E LOCAL:

          Estudo retrospectivo, realizado em um hospital terciário e de ensino.

          MÉTODOS:

          Foram estudados pacientes com torção testicular aguda confirmada na cirurgia, durante o período de abril de 2006 a março de 2011. Informações sobre as condições climáticas no início dos sintomas foram coletadas.

          RESULTADOS:

          Um total de 64 casos de torção testicular foi identificado. Os meses com maiores incidências foram junho (16%), julho (19%) e agosto (11%), que assinalaram as menores temperaturas médias, de 17,6 °C, 16,4 °C e 18,2 °C, respectivamente. Onze por cento dos casos ocorreram durante a primavera (outubro a dezembro), 16% no verão (janeiro a março), 34% no outono (abril a junho) e 39% no inverno (julho, agosto, setembro). Houve associação significante entre a incidência de torção testicular e a estação (outono e inverno), P < 0,001.

          CONCLUSÃO:

          Torção testicular obedece a uma predileção sazonal mesmo num país tropical, sendo mais frequente nos meses mais frios do ano, particularmente no outono e inverno, quando ocorrem quase três quartos dos casos. Estes achados acrescentam evidência a um papel etiológico do clima frio na torção testicular.

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          Most cited references28

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          Testicular torsion in Bristol: a 25-year review.

          To identify changes in incidence, presentation, management and outcome, 670 patients with torsion of the spermatic cord presenting in Bristol between 1960 and 1984 have been reviewed. Among the susceptible population of 150,000, the annual incidence of torsion has increased fourfold from 11.2 cases between 1960 and 1964 to 42.8 cases between 1980 and 1984. Throughout this period greater than 90 per cent of patients have been managed by general surgeons. Patients aged between 12-18 years comprised 62 per cent but 20 per cent were 21 years or older. Torsion was commoner in the cold months, 24 per cent of cases occurring during December and January (chi 2 = 30.26, P less than 0.01). When acute torsion was relieved within 12 h of the onset of symptoms only 4 per cent of affected testes were considered non-viable, but beyond this time 75 per cent of patients received orchidectomy. Overall, 238 of 624 (38 per cent) acutely twisted testes were found to be infarcted at operation, and a further 35 patients (6 per cent) had marked testicular atrophy on review 3 months later. The testicular salvage rate has steadily improved from 45 per cent in the years 1960-64 to 67 per cent in 1980-84. Much of the increased incidence of testicular torsion is likely to reflect a greater awareness of the condition by general practitioners. It has been more than matched by an improvement in testicular salvage rate because of earlier referral.
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            Testicular salvage and age-related delay in the presentation of testicular torsion.

            Testicular torsion represents a continuing source of morbidity among male patients. Early diagnosis and surgical exploration improve testis salvage but even this approach will result in orchiectomy if there is excessive delay in patient presentation. A 10-year retrospective review of testicular torsion was performed. The interval between onset of scrotal pain and presentation to the emergency department was determined. A specific age-related delay in presentation was identified between patients less than 18 years old (group 1, median delay 20 hours) and those greater than 18 years old (group 2, median delay 4 hours, p less than 0.001). At exploration 44 per cent of the group 1 patients required orchiectomy versus 8 per cent in group 2. Patients less than 18 years old are a high risk group for testicular loss after torsion and represent more than 90 per cent of the orchiectomies performed. We believe that this group should be targeted for improved health education, emphasizing early evaluation of scrotal pain to improve testicular salvage.
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              • Article: not found

              Adult testicular torsion.

              Testicular torsion in adulthood is thought to be relatively unusual. We compared a series of men 21 years old or older with testicular torsion with a concurrent series of younger patients with torsion. We reviewed the medical records of patients admitted with testicular torsion in a 9-year period to hospitals affiliated with our institution. Data included patient demographics, history, physical findings, radiographic results if any, operative findings and outcome (testicular salvage versus loss). The charts of 48 patients were evaluated. Excluded from study was a neonate with torsion and 3 males who underwent delayed surgery for presumed missed torsion. Of the remaining 44 patients we compared 17 who were 21 years old or older (range 21 to 34) with 27 younger than 21 (range 8 to 20). The salvage rate differed in the 2 age groups with 70.3% of testes salvaged in the younger group versus only 41% in the older group. A factor affecting salvage in each group was time to presentation. In the older age group patients in whom the testis was lost had a significantly higher mean delay in presentation than those in whom it was salvaged (102 versus 11 hours). A similar pattern was noted in the younger group with a mean time to presentation of 108 and 6.5 hours in those with testicular loss and salvage, respectively. Mean time between presentation and operation was 7.1 hours in the older and 4.8 in the younger group, which was not statistically different. A significant difference was noted in the degree of spermatic cord twisting. The cord was twisted a mean of 585 degrees in the adults versus 431 in the younger group. Testicular torsion in adults was more common in our series than expected. Salvage of the affected testis was better in younger patients, presumably due to less twisting of the cord.
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                Author and article information

                Journal
                Sao Paulo Med J
                Sao Paulo Med J
                Sao Paulo Med J
                São Paulo Medical Journal
                Associação Paulista de Medicina - APM
                1516-3180
                1806-9460
                26 September 2014
                2015
                : 133
                : 3
                : 187-190
                Affiliations
                [I ] originalMD. Attending Physician, Department of Urology, Hospital Santa Marcelina, São Paulo, Brazil.
                [II ] originalMD. Senior Resident, Department of Urology, Hospital Santa Marcelina, São Paulo, Brazil.
                [III ] originalMD. Attending Physician, Department of Pediatric Surgery, Hospital Santa Marcelina, São Paulo, Brazil.
                [IV ] originalMD. Department Head, Department of Urology, Hospital Santa Marcelina, São Paulo, Brazil.
                Author notes
                Address for correspondence: Daniel Oliveira. Rua da Paz, 321 - Apto 802. CEP 60165-180. Meireles - Fortaleza (CE) - Brasil. E-mail: danieldeoliveira80@ 123456gmail.com

                Conflict of interest: None

                Article
                10.1590/1516-3180.2013.7600007
                10876364
                25271876
                7c91f850-62e2-44b5-91c4-737b746d01d4

                This is an open access article distributed under the terms of the Creative Commons license.

                History
                : 28 August 2013
                : 07 November 2013
                : 30 January 2014
                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 23, Pages: 4
                Categories
                Original Article

                spermatic cord torsion,incidence,cold climate,seasons,brazil,torção do cordão espermático,incidência,clima frio,estações do ano,brasil

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