Torsion of the spermatic cord is responsible for an ischemic necrosis of the testis in the absence of rapid resaturation of the perfusion. It is also responsible for contralateral parenchymal alterations resulting in subfertility. Torsion of the spermatic cord mostly occurs in newborns and adolescents. Its classical clinical pattern is that of an acute-onset ipsilateral scrotal pain. Its diagnosis is clinical and its suspicion must lead to an immediate surgical scrotal exploration. The surgical procedure may be preceded by an attempt of external detorsion, but never delayed by any para clinical exploration. If the diagnosis is confirmed at surgery, contra-lateral orchidopexy must be considered. Trophicity of the ischemic testicle and the fertility of the patient are uncertain. Improvement of the prognosis of patients with torsion of the spermatic cord needs an urgent surgical management of the patients. It also claims for the development of testicular parenchyma protective medical treatments. But the most important improvement should come from parental and teenagers educational information so that they urgently visit a practitioner in case of acute scrotal pain.