Testicular torsion leading to orchidectomy is a major catastrophe for the patient and continues to occur. We studied the causes of delay leading to orchidectomy by conducting a retrospective hospital-based audit of all patients undergoing scrotal exploration for suspected testicular torsion over a 2 year period. Fifty patients underwent surgery of whom 22 (44%) had testicular torsion and six required orchidectomy. All patients with a dead testicle presented more than 6 h after onset of symptoms. Of those presenting with 6, 24 or more than 24 h of symptoms, salvageable testes were found in 100%, 83% and 75%, respectively. The median duration of symptoms in patients with viable twisted testicle was 5.5 h compared with 42 h in those who underwent orchidectomy. Late presentation to hospital was the major cause of delay leading to orchidectomy in patients with testicular torsion. Greater effort in health education and direct or self-referral to hospital may reduce this delay.