Introduction: Testicular torsion (TT) is time-critical and leaving the cord twisted while awaiting theatre or transfer risks avoidable ischaemia. Manual detorsion (MD) may rapidly restore perfusion but is inconsistently taught: 25% of trainees report never being taught or not believing in it, and only 31% of Australians report ever performing MD. We aimed to assess whether MD should be recommended by summarising success, residual torsion at exploration, and gonadal outcomes after successful vs failed MD. Methods: We analysed observational cohorts reporting MD prior to operative management. Outcomes are noted as MD success (when clinical improvement coincided with restored flow on colour Doppler), residual torsion at exploration, and orchidectomy stratified by MD outcome. Results: In a paediatric cohort (n=276), MD was attempted in 56.5% and succeeded in 43.6%; no gonadal loss followed successful MD, although residual partial-torsion was found at exploration (4.4%) and none required orchidectomy (0%). In the paediatric cohort, 24.6% of patients had an elective surgery within 3 days. In an adult cohort (n=62), MD succeeded in 58.1%; and among presentations <24 h, orchidectomy rate was 2.9% after successful MD vs 42.1% after failed MD. Conclusion: MD can promptly restore perfusion in many suspected torsion cases and may reduce avoidable ischaemic time which is crucial when theatre access or transfer is delayed. Given the benefit when successful and significant gaps in clinical application, we propose MD should be routinely taught and attempted at the instance of clinical TT diagnosis while not delaying definite scrotal exploration. References: Dewan, P., Kowlessur, B., & Lazarus, J. (2016).A survey of manual detorsion of the testicle. JOJ Urology & Nephrology Ribeiro, S., Campos, J. M., & Vasconcelos-Castro, S. (2025).Lessons learned after 10 years of manual detorsion in testicular torsion. Journal of Paediatric Urology