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Testicular torsion is a condition in which the blood vessels supplying the testicles become twisted, resulting inischemia and an acute scrotum. It is a urologic emergency that requires prompt surgical intervention to preventtesticular loss and subsequent infertility. The incidence of acute scrotum cases due to testicular torsion has beenincreasing, leading to morbidity, infertility, and psychological distress. This study aimed to determine theincidence and factors associated with early adverse outcomes of testicular torsion in patients with acute scrotum inselected hospitals in western Uganda. The study was a prospective observational study conducted at HoimaRegional Referral and Kampala International University Teaching Hospitals. Patients with acute scrotum wereenrolled and evaluated for testicular torsion. Those diagnosed with torsion underwent surgery, and the outcome interms of salvageability of the testis was recorded. The data were analyzed using SPSS version 22. During thestudy period, 232 patients with acute scrotum were enrolled, with a mean age of 35.3 (SD = 20.4) years. Out ofthese, 41 (17.7%) were diagnosed with testicular torsion. Only 16 (39.02%) of the torsion cases had a viable testisthat could be salvaged, while 25 (60.98%) required orchiectomy. Multivariate analysis showed that patients whopresented after 48 hours from the onset of symptoms were 34.833 times more likely to undergo orchiectomycompared to those who presented within 12 hours (AOR=34.833, CI=5.020-60.711, P<0.001). This study founda high incidence of testicular torsion and a significant proportion of patients requiring orchiectomy. The onlyindependent factor associated with orchiectomy was the duration from symptom onset to exploration. It isimportant to educate males about the clinical signs of testicular torsion to ensure early presentation, which canincrease salvage rates and reduce the need for orchiectomy.Keywords: Acute scrotum, Testicular torsion, Male infertility, Orchiectomy