Erdem ÖZATMAN, Rifat Burak ERGÜL, Reşat AYDIN, Muhammet İrfan DÖNMEZ, Tayfun OKTAR, Hasan Orhan ZİYLAN, İsmet NANE

Soğuk Hava Testisin Dostu mu Düşmanı mı?

Amaç: Testis torsiyonu (TT), testis ve spermatik kordun ekseni etrafında dönüşü ile karakterize akut skrotal ağrıya neden olan acil bir ürolojik patolojidir. Düşük hava sıcaklığının predispozan etkisini gösteren çalışmalar mevcuttur. Bu çalışmada TT’nin soğuk hava ile olan ilişkisinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: 2005-2021 yılları arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi Üroloji AD Çocuk Ürolojisi BD’na skrotal ağrıyla başvurup, muayene ve skrotal doppler ultrasonografi sonrası TT ön tanısıyla cerrahi eksplorasyon yapılan 75 erkek hastanın dosyası geriye dönük incelendi. Hastaların yaş ortalaması, başvuru tarihi, torsiyon tarafı ve yapılan girişimler kaydedildi. Meteoroloji Genel Müdürlüğü’nden İstanbul ili için son 16 yılın aylık ortalama hava sıcaklığı değerleri alındı. Ortalama hava sıcaklığının en yüksek olduğu aydan en düşük olduğu aya doğru sıralama yapıldı. Sıcak ve soğuk aylar olarak iki gruba ayrıldı. Bulgular: Hastalar cerrahi eksplorasyon esnasında ortalama 17.02 ± 0.78 yaşındaydı. Sağ testis torsiyonu 49 (%67,1), sol testis torsiyonu 23 (%31,5), bilateral torsiyon ise 1 (%1,4) hastada görüldü. Eksplore edilen hastaların 2’sinde ise (%2,6) TT olmadığı saptandı ve bu hastalar çalışma dışı bırakıldı. Tüm olgularda intravaginal torsiyon vardı. Hastaların aylara göre dağılımı ve ayların ortalama sıcaklık değerleri Şekil 1’de gösterilmiştir. Son 16 yılın ortalama hava sıcaklığı Ağustos’ta 26,0°C ile en yüksek, Ocak’ta 6,9°C ile en düşüktü. Nisan - Eylül arası sıcak aylar, Ekim - Mart arası ise soğuk aylar olarak adlandırıldı. Sıcak ayların ortalama sıcaklığı 21,8°C iken, soğuk aylarınki 10,2°C idi. Sıcak aylarda 41 (%56,2), soğuk aylarda 32 (%43,8) hastada testis torsiyonu geliştiği saptandı. Hastaların 50’sine (%68,5) detorsiyon ve fiksasyon, 18’ine (%24,6) orşiektomi, 5’ine (%6,9) manuel detorsiyon yapıldı. Detorsiyon ve fiksasyon yapılan 6 (%8,2) hastada kontralateral orşiektomi geçmişi vardı. Sonuç: Çalışmamızda literatürdeki düşük sıcaklıkta TT insidansının arttığına yönelik bilginin tersi ortaya konmuştur. Sıcaklığın yüksek olduğu 6 ayda TT nedeniyle başvurular daha fazladır. Ayrıca yaz tatilinde çocukların şehir dışına seyahat ettiği varsayılarak, sıcak aylarda hasta sayısının daha fazla olabileceği öngörülmüştür. Farklı bölgelerden çok merkezli çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler:

sıcaklık, mevsimsel değişimler, spermatik kord torsiyonu, testis, testis torsiyonu

Is Cold Weather Testicle’s Friend or Foe?

Objective: Low air temperature has been shown to predispose testicular torsion (TT). In this study, we aimed to examine the relationship of TT occurrence with monthly average temperature. Materials and Methods: The files of 75 male patients who were admitted with acute scrotum between 2005 and 2021 and underwent intervention with a preliminary diagnosis of TT after examination were retrospectively analyzed. The mean age, date of admission, torsion side and interventions were recorded. All patients underwent scrotal doppler ultrasonography. Further, monthly average temperature values of the given years for the province were obtained from the General Directorate of Meteorology. Months were ranked in descending order in terms of average monthly temperature and divided into two groups as warmer and colder months. Results: The mean age of the patients at the time of intervention was 17.02±0.78 years. TT was seen on the right side in 49(67.1%) patients, left side in 23(31.5%) and bilateral in 1(1.4%) patient. Two (2.6%) patients turned out not to have TT and were excluded from the study. The warm months were those from April to September, and the cold months from October to March. It was determined that testicular torsion developed in 41 (56.2%) patients in the warm months and in 32 (43.8%) patients in the cold months. Detorsion and fixation were performed in 50(68.5%) of the patients, orchiectomy in18 (24.6%) and manual detorsion preceded by fixation in another session in 5 (6.9%) patients. Conclusion: Our results indicated that TT may be observed more frequently in warm months. Thus, TT might not be related to seasonal temperature changes.

Keywords:

temperature, seasonal variations, spermatic cord torsion, testis, testicular torsion,

PDF

___

Barada JH, Weingarten JL, Cromie WJ. Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol 1989;142:746-748. google scholar
Srinivasan AK, Freyle J, Gitlin JS, Palmer LS. Climatic conditions and the risk of testicular torsion in adolescent males. J Urol 2007;178:2585-2588; discussion 2588. google scholar
Seng YJ, Moissinac K. Trauma induced testicular torsion: a reminder for the unwary. J Accid Emerg Med 2000;17:381-382. google scholar
Parker RM, Robison JR. Anatomy and diagnosis of torsion of the testicle. J Urol 1971;106:243-247. google scholar
Ferreira U, Netto Junior NR, Esteves SC, Rivero MA, Schirren C. Comparative study of the fertility potential of men with only one testis. Scand J Urol Nephrol 1991;25:255-259. google scholar
Romeo C, Impellizzeri P, Arrigo T, Antonuccio P, Valenzise M, Mirabelli S, et al. Late hormonal function after testicular torsion. J Pediatr Surg 2010;45:411-413. google scholar
Korkes F, Cabral PR, Alves CD, Savioli ML, Pompeo AC. Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil. Int Braz J Urol 2012;38:222-228; discussion 228-229. google scholar
Barnett AG. Turning temperature measures outside-in. Epidemiology 2015;26:e11-12. google scholar
Cuckow PM, Frank JD. Torsion of the testis. BJU Int 2000;86:349-353. google scholar
Cost NG, Bush NC, Barber TD, Huang R, Baker LA. Pediatric testicular torsion: demographics of national orchiopexy versus orchiectomy rates. J Urol 2011;185:2459-2463. google scholar
Chen JS, Lin YM, Yang WH. Diurnal temperature change is associated with testicular torsion: a nationwide, population based study in Taiwan. J Urol 2013;190:228-232. google scholar
Driscoll PA, Brume J, Meehan SE. Cold weather and testicular torsion. Br Med J (Clin Res Ed) 1983;286:1751. google scholar
Hoshino H, Abe T, Watanabe H, Katsuoka Y, Kawamura N. [Correlation between atmospheric temperature and testicular torsion]. Hinyokika Kiyo 1993;39:1031-1033; discussion 1033-1034. google scholar
Preshaw RM. Seasonal frequency of testicular torsion. Can J Surg 1984;27:404-405. google scholar
Mabogunje OA. Testicular torsion and low relative humidity in a tropical country. Br Med J (Clin Res Ed) 1986;292:363-364. google scholar
Karakan T, Bagcioglu M, Ozcan S, Telli O, Turgut H, Ozkan M, et al. Seasonal preponderance in testicular torsion: is it a myth? Arch Esp Urol 2015;68:750-754. google scholar
Williams CR, Heaven KJ, Joseph DB. Testicular torsion: is there a seasonal predilection for occurrence? Urology 2003;61:638-641; discussion 641. google scholar