Testicular and spermatic cord torsion is a urological emergency, which is easily misdiagnosed as acute testicular and epididymitis at the initial diagnosis, and delayed treatment may result in testicular necrosis and removal. Testicular and spermatic cord torsion is one of the common urological emergencies, but this emergency is often overlooked by laymen. There are two types of testicular and spermatic cord torsion: intrasphincteric and extrasphincteric, with the extrasphincteric type being seen in newborns and the intrasphincteric type in adolescents. Testicular torsion can occur at any age, but is more common in adolescents. The “pendulum deformity” is the anatomical basis for testicular torsion. The “pendulum deformity” is caused by a variation in the attachment of the testicular sheath, which increases the mobility of the testis and predisposes it to torsion. Barada et al. (Barada, 1989) reported that the incidence of testicular torsion under the age of 25 is approximately 1 in 4000 and is the most common cause of testicular loss in young men. Testicular and spermatic cord torsion is more common on the left side, which may be related to the longer spermatic cord on the left side. Testicular torsion can occur at any age, and the exact mechanism of occurrence is not clear, and it is easily misdiagnosed clinically as other diseases, often leading to testicular necrosis and atrophy. Therefore, early diagnosis is very important. Once the diagnosis is established, early surgical exploration and treatment is essential. Two-dimensional ultrasound of the scrotum and color ultrasound blood flow imaging can help in the early diagnosis of testicular torsion. The two-dimensional ultrasound and color ultrasound of testicular and spermatic cord torsion are characterized by the change of position of the testis and epididymis in the scrotum and the decrease or disappearance of blood flow signal in the testis, while in testicular and epididymitis, the blood flow in the testis and epididymis increases, which can be used for differential diagnosis. The sensitivity of color Doppler flow dynamic imaging for the diagnosis of testicular and spermatic cord torsion is 82% and the specificity is 100% (Wibert, 1993). The acute ischemia of testicular and spermatic cord torsion can lead to testicular necrosis and should be treated with urgent surgical exploration. The literature reports that if the testis can be reset within 5 h of torsion, the testicular salvage rate is 83%, 70% within 10 h, and drops to 20% for those who exceed 10 h. Beyond 24 h, testicular necrosis is often inevitable. Intraoperatively, the decision to preserve the testis is based on the blood supply to the testicular tissue. Based on the fact that the anatomical abnormalities of testicular torsion are mostly bilateral, most scholars advocate simultaneous fixation of the contralateral testis. In the early stage of testicular spermatic cord torsion (<6h), when there is no intracapsular ooze and no skin edema, early surgical repositioning is feasible. The testicular spermatic cord should be repositioned in different rotational directions according to the direction of torsion, and manual repositioning is somewhat blind, even if successful, there is a possibility of re-torsion. In conclusion, early diagnosis and early treatment is the key to the diagnosis and treatment of testicular and spermatic cord torsion.