Do you need to perform an emergent orchiopexy on a patient who presents with acute onset testicular pain and scrotal ultrasound shows whirlpool sign but there is arterial flow to the testicle?

I would at least council the family/offer an urgent orchidopexy in this situation. In the practice at my hospital, we have sent someone home in this situation who came back with a non viable testis.

Chances are that they will bounce back in a short period of time, so I would offer urgent surgery - bilateral septopexy.

Initially, the twist is just enough to block venous flow and, as the testis engorges, it twists more and cuts off arterial flow. It is best to intervene early. Since the bell clapper deformity is bilateral in 40% of patients, it is best to do bilateral orchiopexy. This adds just a couple of minutes ...