Laparoscopic-to-open orchiectomy for an atrophic undescended testis in an adult: a case report

Adult presentation of an undescended testis is rare and can pose significant surgical challenges due to anatomical distortion, fibrosis, and diagnostic ambiguity. Early identification and appropriate surgical planning are essential to avoid complications and the risk of malignancy.

A 32-year-old male presented with intermittent right lower-abdominal discomfort. Physical examination revealed an empty right hemiscrotum. Ultrasound localized an atrophic undescended testis near the superficial inguinal canal, although a small retroperitoneal lesion had initially been suspected. Diagnostic laparoscopy was initiated, but was converted to an open inguinal approach because of dense adhesions and unclear tissue planes. The testis was fibrotic, severely atrophic, and adherent to the inferior epigastric vessels. Right orchiectomy was successfully performed, and histopathology confirmed total seminiferous tubule atrophy without malignancy.

This case illustrates the technical difficulty of managing long-standing adult cryptorchidism. Extensive peritesticular fibrosis and aberrant anatomy may obscure key landmarks, increasing the risk of vascular or visceral injury. A flexible laparoscopic-to-open strategy and meticulous dissection are crucial for safe surgical management.

Adult cryptorchidism can pose unexpected intraoperative challenges. Individualized surgical planning and readiness for open conversion are vital to achieving optimal outcomes and minimizing complications.