title: Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Division of Urology, ABC Medical School, São Paulo, Brazil. fkorkes@terra.com.br
authors.forename: Fernando
authors.initials: F
authors.lastname: Korkes
authors.forename: Paulo Roberto dos Anjos
authors.initials: PR
authors.lastname: Cabral
authors.forename: Caio Dal Moro
authors.initials: CD
authors.lastname: Alves
authors.forename: Mariana Lorenzi
authors.initials: ML
authors.lastname: Savioli
authors.forename: Antonio Carlos Lima
authors.initials: AC
authors.lastname: Pompeo
mesh_terms: D000704:Analysis of Variance; D001938:Brazil / Q000453:epidemiology; D003080:Cold Temperature / Q000009:adverse effects*; D006751:Hospital Information Systems; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D012018:Reflex; D012621:Seasons; D013086:Spermatic Cord Torsion / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery