Adult atrophic cryptorchidism requiring conversion from laparoscopic to open orchiectomy: a case report and narrative review

Introduction: Adult cryptorchidism is rare and remains a challenge because of testicular atrophy, infertility, and the risk of malignancy. We report a surgically complex case, along with a narrative review of the current literature. Presentation of the case: A 30-year-old man presented with intermittent lower abdominal pain. Imaging revealed a severely atrophic, undescended right testis in the superficial inguinal pouch. Laparoscopy identified dense fibrosis around the distal spermatic cord and external inguinal ring, requiring conversion to an open inguinal orchiectomy. Histopathology demonstrated complete seminiferous tubular atrophy, interstitial fibrosis, and focal Leydig-cell hyperplasia without malignancy. Clinical discussion: Management should be individualized according to testicular viability, fertility and endocrine potential, malignancy risk, and patient preferences. Dense fibrosis and vascular adherence may prevent safe laparoscopic dissection despite preoperative localization, making conversion to an open approach an appropriate safety strategy. Conclusion: Conversion to open surgery is a deliberate safety strategy when fibrosis and distorted anatomy prevent safe laparoscopic dissection and vascular control. The decision to convert should be guided by operative findings and patient safety, rather than by persistence with a minimally invasive approach.