Surgical treatment is the main treatment, involving exploration of the scrotum, untwisting the testis and assessing return of circulation. A viable testicle is then stitched onto the scrotal wall, whilst an unviable testis is removed. The unaffected testicle is also explored and sutured due to future risk of torsion in the unaffected testicle (bellclapper deformity is likely bilateral). If absorbable sutures are used then there is risk of retorsion. There is a good salvage rate within 6 hours of torsion

Manual untwisting can be a temporising measure whilst awaiting theatre or where surgery is not available/an option. This involves local anaesthetic infiltration of the spermatic cord (note, this may mask the procedural endpoint which is pain relief), with manual untwisting of the affected testicle away from the midline (described as ‘opening a book’), up to 2-3 times. If this reduces pain, continue to twist, however if this worsens pain, try twisting in an opposing direction. Whilst manual untwisting is an option, this does not negate the need for surgery, nor should it delay operating.