Seasonal and climatic variations in the incidence and laterality of testicular torsion in an equatorial setting: A five-year retrospective study

Seasonal and climatic variations in the incidence and laterality of testicular torsion in an equatorial setting: A five-year retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Seasonal and climatic variations in the incidence and laterality of testicular torsion in an equatorial setting: A five-year retrospective study Alastair Mope Simo, David Kabaa Kimani, Tim Jumbi, Jude Moutchia, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9076415/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Testicular torsion (TT) is a time-sensitive urological emergency associated with high rates of testicular loss when diagnosis or intervention is delayed. Seasonal patterns have been described in temperate regions, with higher incidence during colder months, but evidence from equatorial settings is limited and inconsistent. Identifying high-risk periods may improve vigilance and promote earlier presentation. Objective To evaluate seasonal and climatic variation in the incidence and laterality of TT at a national referral hospital in Kenya. Methods We conducted a retrospective analytical study of all surgically confirmed TT cases at Kenyatta National Hospital (KNH) between January 2021 and December 2025. Clinicodemographic and operative data were extracted from medical records. Monthly temperature and humidity data were obtained from the Kenya Meteorological Department and matched to cases by date of presentation. Seasonal variation was analyzed using chi-square testing. Associations between climatic variables and torsion incidence were assessed using Poisson regression. Climatic differences by laterality were evaluated using independent t-tests. Results A total of 181 patients were included (median age 18 years, IQR 15–22), with 73.5% aged 13–25 years. Orchidectomy was performed in 74.6% of cases. TT incidence varied significantly by season, with increased presentations during colder months. There was a significant inverse association between average minimum monthly temperature and torsion incidence, with a 13% reduction in incidence per °C increase (IRR 0.87; 95% CI 0.78–0.97; p = 0.016). Humidity was not associated with incidence (p = 0.283). Right-sided torsion predominated overall (56.4%). No climatic variables were associated with laterality. Conclusion In this equatorial setting, TT demonstrates significant seasonal variation, with increased incidence during colder periods and lower ambient temperatures. Temperature - but not humidity - is independently associated with torsion occurrence. Laterality appears unrelated to climatic factors. Heightened clinical vigilance during colder seasons may facilitate earlier diagnosis and reduce delays to intervention, potentially improving testicular salvage. Testicular torsion Seasonality Temperature Laterality Equatorial climate Kenya Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Background Testicular torsion (TT) is an acute urological emergency caused by twisting of the spermatic cord, leading to ischemia and potential testicular infarction. Salvage rates decline significantly beyond 6 hours from symptom onset. TT predominantly affects adolescents and young adults, with a recognized peak during puberty ( 1 – 3 ). Several studies from North America, Europe, and parts of South America have demonstrated seasonal variation in TT incidence, with increased cases during colder months ( 4 – 6 ). Proposed mechanisms include cold-induced cremasteric contraction and increased testicular mobility in anatomically predisposed individuals, such as those with bell-clapper deformity ( 7 ). However, most available data originate from temperate climates. Evidence from equatorial regions remains sparse and inconsistent. Kenya presents a unique setting: despite its equatorial location, it experiences defined seasonal periods, including cooler months (June–September), long rains, short rains, and hot dry seasons ( 8 , 9 ). Additionally, while left-sided predominance of TT has been widely reported globally, data from sub-Saharan Africa are limited, and climatic influences on laterality remain poorly explored ( 10 , 11 ). This study aimed to evaluate seasonal distribution, climatic associations, and laterality patterns of TT at Kenya’s largest national referral hospital. Methods Study design and setting This retrospective analytical cross-sectional study was conducted at Kenyatta National Hospital, Kenya’s largest tertiary referral and teaching hospital. Study population All male patients of any age with surgically confirmed TT between January 2021 and December 2025 were included. Exclusion criteria Incomplete records Torsion of appendages Neonatal torsion Disorders of sexual development Prior torsion outside the acute phase Data collection Clinicodemographic data (age, residence, date of presentation, symptom timing, laterality, surgical management) were extracted from medical records. Meteorological data (average minimum monthly temperature and average monthly humidity) were obtained from the Kenya Meteorological Department and matched by date and month of presentation. Seasonal classification Seasons were defined as: Hot/dry: January–February Long rains: March–May Cold/dry: June–September Short rains: October–December Statistical analysis Data were analyzed using R software. Descriptive statistics summarized demographic and clinical variables. Chi-square testing assessed seasonal variation. Poisson regression evaluated associations between climatic variables and monthly torsion incidence. Independent t-tests assessed climatic differences by laterality. Statistical significance was set at p < 0.05. Ethical approval Ethical approval was obtained from the KNH–University of Nairobi Ethics Review Committee. Consent was waived due to the retrospective design. Data were anonymized prior to analysis. Results Patient characteristics Of 191 records reviewed, 181 met inclusion criteria. Median age was 18 years (IQR 15–22), with 73.5% aged 13–25 years. Most patients resided in Nairobi County (72.9%). Cases were evenly distributed across the five study years (Table 1). Table 1: Clinicodemographic characteristics of Testicular Torsion patients at KNH Characteristic Overall, N=181 (%) Age <13 years, N=22 (%) Age ≥13 years, N=159 (%) Median Age (IQR) in years 18 (15 - 22) 7 (0.75 - 12) 19 (16 - 26) Age group 22 (12.2) 159 (77.8) 25 years 26 (14.4) County of residence Kajiado 11 (6.1) Kiambu 27 (14.9) Nairobi 132 (72.9) Other 11 (6.1) Year of presentation 2021 38 (21.0) 3 (13.6) 35 (22.0) 2022 30 (16.6) 6 (27.3) 24 (15.1) 2023 40 (22.1) 5 (22.7) 35 (22.0) 2024 32 (17.7) 4 (18.2) 28 (17.6) 2025 41 (22.7) 4 (18.2) 37 (23.3) Orchidectomy was performed in 74.6% of cases (Table 2). Table 2: Clinicodemographic characteristics of Testicular Torsion patients at KNH Surgical Management Overall, N=181 (%) Age <13 years, N=22 (%) Age ≥13 years, N=159 (%) Orchidectomy 135 (74.6) 13 (59.1) 122 (76.7) Orchidopexy 46 (25.4) 9 (40.9) 37 (23.3) Onset of Testicular Torsion Among patients ≥13 years, symptom onset occurred disproportionately during nighttime and early morning hours (p < 0.05). (Figure 1) Seasonal distribution of TT counts TT incidence varied by season, with higher case numbers during colder months. Monthly trends demonstrated recurrent peaks corresponding to cooler periods across multiple years (Figure 2 and 3). Climatic associations with Torsion incidence Temperature There was a significant inverse association between average minimum monthly temperature and torsion incidence. Each 1°C increase in minimum temperature was associated with a 13% reduction in TT incidence (IRR 0.87; 95% CI 0.78–0.97; p = 0.016). (Figure 4 and 5) Humidity Humidity was not significantly associated with torsion incidence (IRR 1.01; 95% CI 0.99–1.03; p = 0.283). (Figure 6) Distribution of Laterality in the study Right-sided torsion occurred in 56.4% of cases. Among patients <13 years, left-sided torsion predominated (63.6%), whereas right-sided torsion was more common in older patients. (Figure 7 and 8) Seasonal distribution of Laterality No consistent seasonal pattern in laterality was observed. (Figure 9) Climatic Association with Laterality Mean temperature and humidity did not differ significantly between left- and right-sided torsion cases (p > 0.05). (Figure 10 and 11) Discussion The majority of testicular torsion cases occurred in adolescents and young adults aged 13 - 25 years, reflecting the well-described peak incidence during puberty, when rapid testicular growth and increased cremasteric activity predispose to torsion (2,3,12). The smaller pediatric peak observed supports the recognized bimodal age distribution reported in existing literature (13). Notably, among patients ≥13 years, symptom onset was more frequent during nighttime and early morning hours, particularly between midnight and 6:00 a.m., coinciding with periods of sleep and lower ambient temperatures. This suggests that torsion may be triggered during rest by sudden cremasteric contraction, potentially influenced by cooler temperatures (14). We found that TT incidence varied significantly by season in an equatorial setting, with increased presentations during colder months. Importantly, we identified a significant inverse relationship between minimum monthly temperature and torsion incidence, suggesting that even modest temperature reductions in tropical climates may influence torsion risk. These findings align with studies from temperate regions reporting winter peaks and support the hypothesis that cold-induced cremasteric contraction may act as a physiological trigger in predisposed individuals (5,6,11). Humidity did not influence torsion incidence, suggesting that temperature rather than atmospheric moisture is the principal environmental factor (7). Interestingly, our cohort demonstrated an overall right-sided predominance, contrasting with many international reports of left-sided predominance (11). Age-stratified analysis revealed a shift toward right-sided torsion in older adolescents and adults, consistent with prior African data (2,15). However, climatic variables did not influence laterality, suggesting that anatomical and developmental factors likely predominate. The orchidectomy rate (74.6%) remains high, reflecting delayed presentation and potential diagnostic challenges. Recognition of seasonal risk patterns may improve clinicians’ early suspicion, promote earlier presentation by the public, and expedite intervention, thereby improving salvage rates. Study Limitations The study encountered the following limitations: Retrospective design limited control over data completeness. However files lacking critical information were excluded. Single centre study: Potentially affecting generalisability of results. Nonetheless, the results should be similar to what obtains in other facilities across Kenya and could serve as a template for comparability and reproducibility in future studies. Lack of anatomical risk-factor data to ascertain causality: However, this information was not obtainable due to the study design and was not an objective of the study; therefore, it does not affect the validity of the main results obtained. Overall, sound methodology was used to ensure clinically relevant data and results were obtained. Conclusion Testicular torsion at a national referral hospital in Kenya demonstrates significant seasonal variation, with increased incidence during colder periods and lower ambient temperatures. Temperature is independently associated with torsion occurrence, while humidity and climatic factors do not influence laterality. Seasonal awareness may support earlier diagnosis and potentially improve testicular salvage in equatorial settings. Abbreviations CI Confidence Interval IQR Interquartile Range IRR Incidence Rate Ratio KNH Kenyatta National Hospital TT Testicular Torsion Declarations Ethics approval and consent to participate Being a retrospective study, consent to participate was not needed. However a waiver of consent was sort for while applying for ethical approval. This study adhered to the Declaration of Helsinki. Consent for Publication Not applicable Availability of Data and Materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding Not Applicable Author’s contributions SAM, DKK, and TJ contributed to the drafting of the main manuscript and the clinical interpretation of the analyzed data. JM performed the data analysis and prepared the figures. KYS was responsible for data collection, data cleaning, and proofreading of the manuscript. Acknowledgements The authors express their sincere appreciation to Monicar Kamau and the staff of the Central Medical Records Department at Kenyatta National Hospital for their prompt assistance with file retrieval. The authors also thank the staff of the Kenya Meteorological Department for providing data on climatic variables in Kenya over a five-year period. Finally, the authors are grateful to their family members and friends for their encouragement and support throughout the course of this research. References Ouattara A, Paré AK, Yé D, Traoré MZ, Simporé M, Rouamba M, et al. Prevalence and Management of Spermatic Cord Torsion (SCT): A Five-Year Review in Souro Sanou University Hospital of Bobo-Dioulasso (Burkina Faso). Res Rep Urol. 2023 Aug 18;15:381–5. doi:10.2147/RRU.S419786 Murithi J, Mwachi A, Abdalla R, Chavda S. Management and Outcome of Testicular Torsion. Ann Afr Surg. 2018 Mar 15;14(2). doi:10.4314/aas.v14i2.11 Ogbetere FE, Urube SU. A five-year review of presentation and management outcome of acute testicular torsion in two Nigerian referral centres. Afr Urol. 2022 Sep 19;2(2):72–5. doi:10.36303/AUJ.0038 Molokwu CN, Ndoumbe JK, Goodman CM. Cold weather increases the risk of scrotal torsion events: results of an ecological study of acute scrotal pain in Scotland over 25 years. Sci Rep. 2020 Oct 21;10:17958. doi:10.1038/s41598-020-74878-0 PubMed PMID: 33087783; PubMed Central PMCID: PMC7578024. Lim ZLT, Chan KJ, Chan E, Ng J, Kim JJY, Chung E, et al. Seasonal Effects of Testicular Torsion in a Region of Australia. J Surg [Internet]. 2024 Dec 14 [cited 2025 Jun 25]. Available from: https://www.gavinpublishers.com/article/view/seasonal-effects-of-testicular-torsion-in-a-region-of-australia Korkes F, Cabral PR dos A, Alves CDM, Savioli ML, Pompeo ACL. Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil. Int Braz J Urol Off J Braz Soc Urol. 2012;38(2):222–8; discussion 228-229. doi:10.1590/s1677-55382012000200010 PubMed PMID: 22555045. Srinivasan AK, Freyle J, Gitlin JS, Palmer LS. Climatic conditions and the risk of testicular torsion in adolescent males. J Urol. 2007 Dec;178(6):2585–8; discussion 2588. doi:10.1016/j.juro.2007.08.049 PubMed PMID: 17945301. Otieno S, Abade E, Oludhe C. A comprehensive review of climate information systems in the arid and semi-arid lands (ASALs) of Kenya for enhanced decision-making process. Inf Dev. 2024 Oct 23;02666669241287498. doi:10.1177/02666669241287498 Nyambariga FK, Opere AO, Kituyi E, Amwata DA. Climate change scenario projections and their implications on food systems in Taita Taveta County, Kenya. PLOS Clim. 2023 Jun 22;2(6):e0000114. doi:10.1371/journal.pclm.0000114 Raffee L, Bani Ali M, Alawneh K, Negresh N, Alawneh H, Al-Shatnawi A, et al. Seasonal Variations in Testicular Torsion: A Retrospective Study. Cureus. 2024 Dec;16(12):e76508. doi:10.7759/cureus.76508 PubMed PMID: 39877779; PubMed Central PMCID: PMC11773996. Rub R, Lidawi G, Laukhtina E, Asali M, Majdoub M. Impact of seasonal variations on incidence and laterality of testicular torsion. Int J Biometeorol. 2023 May;67(5):857–63. doi:10.1007/s00484-023-02460-0 PubMed PMID: 36976325. Li L, Lin W, Wang Z, Huang R, Xia H, Li Z, et al. Hormone Regulation in Testicular Development and Function. Int J Mol Sci. 2024 Jan;25(11):11. doi:10.3390/ijms25115805 Lacy A, Smith A, Koyfman A, Long B. High risk and low prevalence diseases: Testicular torsion. Am J Emerg Med. 2023 Apr 1;66:98–104. doi:10.1016/j.ajem.2023.01.031 Harada J, Mitsunari K, Fukushima H, Kurata H, Nakamura Y, Matsuo T, et al. Are Meteorological Factors, Seasons, and Time of Onset Associated With Acute Scrotum? A Comparative Study of Testicular Torsion and Torsion of the Appendix Testis or Epididymis. Sage Open Pediatr. 2025 Feb 1;12:30502225251325657. doi:10.1177/30502225251325657 Mukendi AM, Kruger D, Haffejee M. Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital. Afr J Urol. 2020 Jul 30;26(1):34. doi:10.1186/s12301-020-00044-7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 May, 2026 Reviews received at journal 04 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviews received at journal 18 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers invited by journal 06 Apr, 2026 Editor assigned by journal 06 Apr, 2026 Editor invited by journal 20 Mar, 2026 Submission checks completed at journal 20 Mar, 2026 First submitted to journal 20 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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A five-year retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eTesticular torsion (TT) is an acute urological emergency caused by twisting of the spermatic cord, leading to ischemia and potential testicular infarction. Salvage rates decline significantly beyond 6 hours from symptom onset. TT predominantly affects adolescents and young adults, with a recognized peak during puberty (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies from North America, Europe, and parts of South America have demonstrated seasonal variation in TT incidence, with increased cases during colder months (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Proposed mechanisms include cold-induced cremasteric contraction and increased testicular mobility in anatomically predisposed individuals, such as those with bell-clapper deformity (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, most available data originate from temperate climates. Evidence from equatorial regions remains sparse and inconsistent. Kenya presents a unique setting: despite its equatorial location, it experiences defined seasonal periods, including cooler months (June\u0026ndash;September), long rains, short rains, and hot dry seasons (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, while left-sided predominance of TT has been widely reported globally, data from sub-Saharan Africa are limited, and climatic influences on laterality remain poorly explored (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aimed to evaluate seasonal distribution, climatic associations, and laterality patterns of TT at Kenya\u0026rsquo;s largest national referral hospital.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective analytical cross-sectional study was conducted at Kenyatta National Hospital, Kenya’s largest tertiary referral and teaching hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll male patients of any age with surgically confirmed TT between January 2021 and December 2025 were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eIncomplete records\u003c/li\u003e\n \u003cli\u003eTorsion of appendages\u003c/li\u003e\n \u003cli\u003eNeonatal torsion\u003c/li\u003e\n \u003cli\u003eDisorders of sexual development\u003c/li\u003e\n \u003cli\u003ePrior torsion outside the acute phase\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinicodemographic data (age, residence, date of presentation, symptom timing, laterality, surgical management) were extracted from medical records.\u003c/p\u003e\n\u003cp\u003eMeteorological data (average minimum monthly temperature and average monthly humidity) were obtained from the Kenya Meteorological Department and matched by date and month of presentation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSeasonal classification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeasons were defined as:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eHot/dry: January–February\u003c/li\u003e\n \u003cli\u003eLong rains: March–May\u003c/li\u003e\n \u003cli\u003eCold/dry: June–September\u003c/li\u003e\n \u003cli\u003eShort rains: October–December\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using R software.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDescriptive statistics summarized demographic and clinical variables.\u003c/li\u003e\n \u003cli\u003eChi-square testing assessed seasonal variation.\u003c/li\u003e\n \u003cli\u003ePoisson regression evaluated associations between climatic variables and monthly torsion incidence.\u003c/li\u003e\n \u003cli\u003eIndependent t-tests assessed climatic differences by laterality.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eStatistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the KNH–University of Nairobi Ethics Review Committee. Consent was waived due to the retrospective design. Data were anonymized prior to analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 191 records reviewed, 181 met inclusion criteria.\u003c/p\u003e\n\u003cp\u003eMedian age was 18 years (IQR 15\u0026ndash;22), with 73.5% aged 13\u0026ndash;25 years. Most patients resided in Nairobi County (72.9%). Cases were evenly distributed across the five study years (Table 1).\u003c/p\u003e\n\u003cp id=\"_Toc219467255\"\u003eTable 1: Clinicodemographic characteristics of Testicular Torsion patients at KNH\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristic\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOverall,\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN=181 (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAge \u0026lt;13 years, N=22 (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAge \u0026ge;13 years, N=159 (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian Age (IQR) in years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e18 (15 - 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e7 (0.75 - 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e19 (16 - 26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAge group\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" rowspan=\"5\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; 22 (12.2) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 159 (77.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026lt;1 year\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e7 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; 1\u0026ndash;12 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e15 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; 13\u0026ndash;25 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e133 (73.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026gt;25 years\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e26 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCounty of residence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" valign=\"top\" style=\"width: 264px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; Kajiado\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e11 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" rowspan=\"4\" valign=\"top\" style=\"width: 264px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; Kiambu\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e27 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; Nairobi\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e132 (72.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; Other\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e11 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eYear of presentation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; 2021\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e38 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e35 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; 2022\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e30 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e24 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; 2023\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e40 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e5 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e35 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; 2024\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e32 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e4 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e28 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; 2025\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e41 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e4 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e37 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Orchidectomy was performed in 74.6% of cases (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Clinicodemographic characteristics of Testicular Torsion patients at KNH\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical Management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=181 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge \u0026lt;13 years, N=22 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge \u0026ge;13 years, N=159 (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrchidectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cem\u003e135 (74.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003e13 (59.1)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003e122 (76.7)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrchidopexy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cem\u003e46 (25.4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cem\u003e9 (40.9)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003e37 (23.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eOnset of Testicular Torsion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong patients \u0026ge;13 years, symptom onset occurred disproportionately during nighttime and early morning hours (p \u0026lt; 0.05). (Figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSeasonal distribution of TT counts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTT incidence varied by season, with higher case numbers during colder months. Monthly trends demonstrated recurrent peaks corresponding to cooler periods across multiple years (Figure 2 and 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClimatic associations with Torsion incidence\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eTemperature\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThere was a significant inverse association between average minimum monthly temperature and torsion incidence. Each 1\u0026deg;C increase in minimum temperature was associated with a 13% reduction in TT incidence (IRR 0.87; 95% CI 0.78\u0026ndash;0.97; p = 0.016). (Figure 4 and 5)\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eHumidity\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eHumidity was not significantly associated with torsion incidence (IRR 1.01; 95% CI 0.99\u0026ndash;1.03; p = 0.283). (Figure 6)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of Laterality in the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRight-sided torsion occurred in 56.4% of cases. Among patients \u0026lt;13 years, left-sided torsion predominated (63.6%), whereas right-sided torsion was more common in older patients. (Figure 7 and 8)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSeasonal distribution of Laterality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo consistent seasonal pattern in laterality was observed. (Figure 9)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClimatic Association with Laterality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMean temperature and humidity did not differ significantly between left- and right-sided torsion cases (p \u0026gt; 0.05). (Figure 10 and 11)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe majority of testicular torsion cases occurred in adolescents and young adults aged 13 - 25 years, reflecting the well-described peak incidence during puberty, when rapid testicular growth and increased cremasteric activity predispose to torsion (2,3,12). The smaller pediatric peak observed supports the recognized bimodal age distribution reported in existing literature (13).\u003c/p\u003e\n\u003cp\u003eNotably, among patients \u0026ge;13 years, symptom onset was more frequent during nighttime and early morning hours, particularly between midnight and 6:00 a.m., coinciding with periods of sleep and lower ambient temperatures. This suggests that torsion may be triggered during rest by sudden cremasteric contraction, potentially influenced by cooler temperatures (14).\u003c/p\u003e\n\u003cp\u003eWe found that TT incidence varied significantly by season in an equatorial setting, with increased presentations during colder months. Importantly, we identified a significant inverse relationship between minimum monthly temperature and torsion incidence, suggesting that even modest temperature reductions in tropical climates may influence torsion risk.\u003c/p\u003e\n\u003cp\u003eThese findings align with studies from temperate regions reporting winter peaks and support the hypothesis that cold-induced cremasteric contraction may act as a physiological trigger in predisposed individuals (5,6,11).\u003c/p\u003e\n\u003cp\u003eHumidity did not influence torsion incidence, suggesting that temperature rather than atmospheric moisture is the principal environmental factor (7).\u003c/p\u003e\n\u003cp\u003eInterestingly, our cohort demonstrated an overall right-sided predominance, contrasting with many international reports of left-sided predominance (11). Age-stratified analysis revealed a shift toward right-sided torsion in older adolescents and adults, consistent with prior African data (2,15). However, climatic variables did not influence laterality, suggesting that anatomical and developmental factors likely predominate.\u003c/p\u003e\n\u003cp\u003eThe orchidectomy rate (74.6%) remains high, reflecting delayed presentation and potential diagnostic challenges.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecognition of seasonal risk patterns may improve clinicians\u0026rsquo; early suspicion, promote earlier presentation by the public, and expedite intervention, thereby improving salvage rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study encountered the following limitations:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eRetrospective design limited control over data completeness. However files lacking critical information were excluded.\u003c/li\u003e\n \u003cli\u003eSingle centre study: Potentially affecting generalisability of results. Nonetheless, the results should be similar to what obtains in other facilities across Kenya and could serve as a template for comparability and reproducibility in future studies.\u003c/li\u003e\n \u003cli\u003eLack of anatomical risk-factor data to ascertain causality: However, this information was not obtainable due to the study design and was not an objective of the study; therefore, it does not affect the validity of the main results obtained.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOverall, sound methodology was used to ensure clinically relevant data and results were obtained.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTesticular torsion at a national referral hospital in Kenya demonstrates significant seasonal variation, with increased incidence during colder periods and lower ambient temperatures. Temperature is independently associated with torsion occurrence, while humidity and climatic factors do not influence laterality.\u003c/p\u003e\n\u003cp\u003eSeasonal awareness may support earlier diagnosis and potentially improve testicular salvage in equatorial settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile Range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIncidence Rate Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKNH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKenyatta National Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTesticular Torsion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBeing a retrospective study, consent to participate was not needed. However a waiver of consent was sort for while applying for ethical approval.\u003c/p\u003e\n\u003cp\u003eThis study adhered to the Declaration of Helsinki.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eSAM, DKK, and TJ contributed to the drafting of the main manuscript and the clinical interpretation of the analyzed data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJM performed the data analysis and prepared the figures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKYS was responsible for data collection, data cleaning, and proofreading of the manuscript.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors express their sincere appreciation to Monicar Kamau and the staff of the Central Medical Records Department at Kenyatta National Hospital for their prompt assistance with file retrieval.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors also thank the staff of the Kenya Meteorological Department for providing data on climatic variables in Kenya over a five-year period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, the authors are grateful to their family members and friends for their encouragement and support throughout the course of this research.\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOuattara A, Par\u0026eacute; AK, Y\u0026eacute; D, Traor\u0026eacute; MZ, Simpor\u0026eacute; M, Rouamba M, et al. Prevalence and Management of Spermatic Cord Torsion (SCT): A Five-Year Review in Souro Sanou University Hospital of Bobo-Dioulasso (Burkina Faso). Res Rep Urol. 2023 Aug 18;15:381\u0026ndash;5. doi:10.2147/RRU.S419786\u003c/li\u003e\n \u003cli\u003eMurithi J, Mwachi A, Abdalla R, Chavda S. Management and Outcome of Testicular Torsion. Ann Afr Surg. 2018 Mar 15;14(2). doi:10.4314/aas.v14i2.11\u003c/li\u003e\n \u003cli\u003eOgbetere FE, Urube SU. A five-year review of presentation and management outcome of acute testicular torsion in two Nigerian referral centres. Afr Urol. 2022 Sep 19;2(2):72\u0026ndash;5. doi:10.36303/AUJ.0038\u003c/li\u003e\n \u003cli\u003eMolokwu CN, Ndoumbe JK, Goodman CM. Cold weather increases the risk of scrotal torsion events: results of an ecological study of acute scrotal pain in Scotland over 25 years. Sci Rep. 2020 Oct 21;10:17958. doi:10.1038/s41598-020-74878-0 PubMed PMID: 33087783; PubMed Central PMCID: PMC7578024.\u003c/li\u003e\n \u003cli\u003eLim ZLT, Chan KJ, Chan E, Ng J, Kim JJY, Chung E, et al. Seasonal Effects of Testicular Torsion in a Region of Australia. J Surg [Internet]. 2024 Dec 14 [cited 2025 Jun 25]. Available from: https://www.gavinpublishers.com/article/view/seasonal-effects-of-testicular-torsion-in-a-region-of-australia\u003c/li\u003e\n \u003cli\u003eKorkes F, Cabral PR dos A, Alves CDM, Savioli ML, Pompeo ACL. Testicular torsion and weather conditions: analysis of 21,289 cases in Brazil. Int Braz J Urol Off J Braz Soc Urol. 2012;38(2):222\u0026ndash;8; discussion 228-229. doi:10.1590/s1677-55382012000200010 PubMed PMID: 22555045.\u003c/li\u003e\n \u003cli\u003eSrinivasan AK, Freyle J, Gitlin JS, Palmer LS. Climatic conditions and the risk of testicular torsion in adolescent males. J Urol. 2007 Dec;178(6):2585\u0026ndash;8; discussion 2588. doi:10.1016/j.juro.2007.08.049 PubMed PMID: 17945301.\u003c/li\u003e\n \u003cli\u003eOtieno S, Abade E, Oludhe C. A comprehensive review of climate information systems in the arid and semi-arid lands (ASALs) of Kenya for enhanced decision-making process. Inf Dev. 2024 Oct 23;02666669241287498. doi:10.1177/02666669241287498\u003c/li\u003e\n \u003cli\u003eNyambariga FK, Opere AO, Kituyi E, Amwata DA. Climate change scenario projections and their implications on food systems in Taita Taveta County, Kenya. PLOS Clim. 2023 Jun 22;2(6):e0000114. doi:10.1371/journal.pclm.0000114\u003c/li\u003e\n \u003cli\u003eRaffee L, Bani Ali M, Alawneh K, Negresh N, Alawneh H, Al-Shatnawi A, et al. Seasonal Variations in Testicular Torsion: A Retrospective Study. Cureus. 2024 Dec;16(12):e76508. doi:10.7759/cureus.76508 PubMed PMID: 39877779; PubMed Central PMCID: PMC11773996.\u003c/li\u003e\n \u003cli\u003eRub R, Lidawi G, Laukhtina E, Asali M, Majdoub M. Impact of seasonal variations on incidence and laterality of testicular torsion. Int J Biometeorol. 2023 May;67(5):857\u0026ndash;63. doi:10.1007/s00484-023-02460-0 PubMed PMID: 36976325.\u003c/li\u003e\n \u003cli\u003eLi L, Lin W, Wang Z, Huang R, Xia H, Li Z, et al. Hormone Regulation in Testicular Development and Function. Int J Mol Sci. 2024 Jan;25(11):11. doi:10.3390/ijms25115805\u003c/li\u003e\n \u003cli\u003eLacy A, Smith A, Koyfman A, Long B. High risk and low prevalence diseases: Testicular torsion. Am J Emerg Med. 2023 Apr 1;66:98\u0026ndash;104. doi:10.1016/j.ajem.2023.01.031\u003c/li\u003e\n \u003cli\u003eHarada J, Mitsunari K, Fukushima H, Kurata H, Nakamura Y, Matsuo T, et al. Are Meteorological Factors, Seasons, and Time of Onset Associated With Acute Scrotum? A Comparative Study of Testicular Torsion and Torsion of the Appendix Testis or Epididymis. Sage Open Pediatr. 2025 Feb 1;12:30502225251325657. doi:10.1177/30502225251325657\u003c/li\u003e\n \u003cli\u003eMukendi AM, Kruger D, Haffejee M. Characteristics and management of testicular torsion in patients admitted to the Urology Department at Chris Hani Baragwanath Academic Hospital. Afr J Urol. 2020 Jul 30;26(1):34. doi:10.1186/s12301-020-00044-7\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Testicular torsion, Seasonality, Temperature, Laterality, Equatorial climate, Kenya","lastPublishedDoi":"10.21203/rs.3.rs-9076415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9076415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTesticular torsion (TT) is a time-sensitive urological emergency associated with high rates of testicular loss when diagnosis or intervention is delayed. Seasonal patterns have been described in temperate regions, with higher incidence during colder months, but evidence from equatorial settings is limited and inconsistent. Identifying high-risk periods may improve vigilance and promote earlier presentation.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate seasonal and climatic variation in the incidence and laterality of TT at a national referral hospital in Kenya.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective analytical study of all surgically confirmed TT cases at Kenyatta National Hospital (KNH) between January 2021 and December 2025. Clinicodemographic and operative data were extracted from medical records. Monthly temperature and humidity data were obtained from the Kenya Meteorological Department and matched to cases by date of presentation. Seasonal variation was analyzed using chi-square testing. Associations between climatic variables and torsion incidence were assessed using Poisson regression. Climatic differences by laterality were evaluated using independent t-tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 181 patients were included (median age 18 years, IQR 15\u0026ndash;22), with 73.5% aged 13\u0026ndash;25 years. Orchidectomy was performed in 74.6% of cases. TT incidence varied significantly by season, with increased presentations during colder months. There was a significant inverse association between average minimum monthly temperature and torsion incidence, with a 13% reduction in incidence per \u0026deg;C increase (IRR 0.87; 95% CI 0.78\u0026ndash;0.97; p\u0026thinsp;=\u0026thinsp;0.016). Humidity was not associated with incidence (p\u0026thinsp;=\u0026thinsp;0.283). Right-sided torsion predominated overall (56.4%). No climatic variables were associated with laterality.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn this equatorial setting, TT demonstrates significant seasonal variation, with increased incidence during colder periods and lower ambient temperatures. Temperature - but not humidity - is independently associated with torsion occurrence. Laterality appears unrelated to climatic factors. Heightened clinical vigilance during colder seasons may facilitate earlier diagnosis and reduce delays to intervention, potentially improving testicular salvage.\u003c/p\u003e","manuscriptTitle":"Seasonal and climatic variations in the incidence and laterality of testicular torsion in an equatorial setting: A five-year retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 02:03:51","doi":"10.21203/rs.3.rs-9076415/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T07:58:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T05:01:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306420851992749686634647226362119023346","date":"2026-05-04T04:13:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T12:04:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6856503460957386274092140045288013528","date":"2026-04-09T07:48:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182550871773933008480390844435048108243","date":"2026-04-08T08:30:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-06T16:31:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T16:29:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-20T09:03:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-20T06:15:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2026-03-20T06:09:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0874b041-2211-4918-bc7d-547063d0e7f0","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-05T07:58:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T05:01:46+00:00","index":38,"fulltext":""},{"type":"reviewerAgreed","content":"306420851992749686634647226362119023346","date":"2026-05-04T04:13:55+00:00","index":37,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T06:53:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 02:03:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9076415","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9076415","identity":"rs-9076415","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}