We report on 55 cases of torsion of spermatic cord. We describe the clinical features and the findings on physical examination as well as other factors such as patient age, past history of transient painful episodes which should prompt us to consider this condition. In our view, immediate surgical exploration is justified in all cases of acute scrotum in patients in the second-third decade of life in whom this condition is suspected. This approach has allowed us to achieve testicular salvage in 76% of the cases immediately postoperatively. Contralateral fixation is mandatory. The possibility that unilateral testicular torsion might cause subsequent infertility from lesion to the contralateral testis probably due to an autoimmune mechanism has led to a reconsideration of radically conservative management of testicular torsion. Testes whose viability is doubtful should be removed. If untwisting and fixation is performed, patients should be followed closely for a long period to evaluate patient fertility.