Acute, nontraumatic scrotal emergency operations were done on 104 patients. The testes were saved in 79 per cent of 67 patients with torsion of the spermatic cord. When the patients who presented late are excluded, aggressive treatment allowed a 93 per cent testicular salvage rate. Spontaneous or manipulative detorsion preoperatively resulted in a 100 per cent testicular salvage rate. If the patient seeks medical advice early a high testicular salvage rate can be obtained by proper diagnosis and prompt, aggressive detorsion either by manipulation when examined initially or at operation. These maneuvers are combined with bilateral orchiopexy to ensure permanent cure.