The key symptoms of testicular torsion are PAIN,
swelling, and discoloration (cyanosis) of the scro-
tum. Symptoms usually appear suddenly, though
some boys or men have recurring symptoms over
time. Because of the structure of the spermatic
cord, testicular torsion most often affects the left
testicle. Chronic symptoms suggest congenital
detachment of the epididymis from the scrotum.
The diagnostic path includes careful physical
assessment of the testicles, usually by a urologist.
ULTRASOUND(usually Doppler ultrasound) can con-
firm the diagnosis.
Treatment, when diagnosis comes within six to
eight hours of the first symptoms, is emergency
surgery to restore the testicle to its normal posi-
tion and attach it to the scrotum (ORCHIOPEXY). The
testicle cannot survive more than six to eight
hours after symptoms emerge; after this time
necrosis (death of the tissue) sets in and the only
treatment is to remove the testicle (ORCHIECTOMY).
With rapid and appropriate treatment the urolo-
gist can save the testicle about 80 percent of the
time. However, testicular atrophy (wasting) and
necrosis (tissue death) remain possible for up to
six months after the surgery to remedy testicular
torsion.
The longer the time between the onset of
symptoms and surgery, the greater the likelihood
for impaired FERTILITY even when the urologist
can save the testicle. This is because the SPERM
that escape into the tissues of the testicle estab-
lish or activate the IMMUNE RESPONSE, which pro-
duces antibodies to the man’s own sperm that
then attack the sperm as the testicles produce
them.
See also EPIDIDYMITIS; GENITAL TRAUMA; HERNIA;
ORCHITIS; SEXUAL HEALTH.
tubal ligation A surgical OPERATIONto sever (cut)
or tie off a woman’s FALLOPIAN TUBESto prevent
PREGNANCY. Tubal ligation is a form of permanent
CONTRACEPTION, sometimes called tying the tubes or
sterilization. There are two fallopian tubes, one
leading from each ovary to the UTERUS. Cutting or
cauterizing the fallopian tubes prevents the union
of OVA, which travel from the OVARIES to the
uterus, and SPERM, which travel from the uterus
toward the ovaries. This blocks fertilization and
prevents pregnancy.
Surgical Procedure
The most common method of tubal ligation is an
abdominal operation usually performed as a
laparoscopic procedure in an AMBULATORY SURGICAL
FACILITY (outpatient or same-day surgery). The
doctor may also perform tubal ligation as an OPEN
SURGERYat the conclusion of a scheduled CESAREAN
SECTION, provided the woman has given informed
consent for the procedure.
The woman first receives ANESTHESIA, which
may be general anesthesia (deep sleep) or regional
anesthesia such as an epidural block. The surgeon
then makes a single incision (called a single punc-
ture technique) or several small incisions near the
area of the navel (belly button) to insert the
laparoscope and operating instruments. The inci-
sions give access to the fallopian tubes. The sur-
geon places surgical clips or uses cautery to close
the tubes. There may or may not be SKINsutures,
depending on the method the surgeon uses. The
operation typically takes 35 to 45 minutes.
The woman spends one to three hours in the
recovery room after the operation, until she
emerges from the effect of the anesthesia. Most
women go home within four to six hours of the
operation. There is some abdominal discomfort for
one to three days, for which the doctor will pre-
scribe or recommend appropriate ANALGESIC MED-
ICATIONS. Full recovery may take two to three
weeks, though many women can return to most
normal activities within a few days. INFERTILITYis
immediate.Risks and Complications
As with any surgery, tubal ligation carries the risk
for excessive bleeding, INFECTION, and reaction to
the anesthesia. However, these complications are
uncommon. Also possible though uncommon is
PELVIC INFLAMMATORY DISEASE(PID), in which infec-
tion becomes widespread within the fallopian
tubes and uterus and may also involve other
abdominal structures. Rarely a fallopian tube may
spontaneously reanastomose (reconnect), result-
ing in unexpected fertility usually detected
through pregnancy.
Complications that may occur months to years
after the operation include abdominal adhesions
(the formation of restrictive SCARtissue within the
abdominal cavity) and ECTOPIC PREGNANCY, a life-tubal ligation 347