To the editors—

Abstract

The commentaries regarding the article by Cortes, et al, J Urol. 2000;163:1290 did not mention another selection bias. Clearly, the 45 boys treated surgically had not had an attempt at hormonal treatment. This group is double the size of the failed hormonal treatment groups. How many boys succeeded with hormonal treatment? How many of the surgically treated boys would have succeeded with hormonal treatment? Are those the boys with the larger number of spermatogonia? Since cryptorchidism is widely regarded as reflecting testicular dysgenesis, these are not irrational or trivial questions.The purpose of the article and of the commentary was not to compare treatment results of hormonal versus surgical therapy in cryptorchidism but to compare the histology of testis exposed to exogenous hormones with those that were not. If, as you suggest, the surgical group had initial hormone therapy then the study would have no controls. The commentary states that the groups are small and varied and recognizes this fact as a weakness of the paper. The paper states that none of the studied children succeeded with hormonal therapy and if testes had descended under the influence of hormones they would have not been biopsied and could not be included in a histology study. It is certainly possible that patients who have successful hormonal therapy for cryptorchidism have different histology than those who fail but the study does not address this question. Again, I see the study as an analysis of the histology of cryptorchid testis after early hormone therapy and comparison of this histology with controls that were not exposed to hormones. Thank you for your comments.