The definitive treatment for testicular torsion is surgical detorsion and orchidopexy because it allows direct visualization and correction of the twisted spermatic cord, restoring blood flow to the testis. Immediate surgical intervention within 6 hours is critical to prevent ischemic damage and testicular loss. Orchidopexy secures both testes to the scrotal wall to prevent recurrence. Manual reduction is often incomplete and should not replace surgery. Observation or antibiotics are ineffective as torsion is a surgical emergency requiring prompt resolution.

Reference: Campbell-Walsh Urology, Wein et al., 12th Edition.