Structural evidence against hormonal therapy for cryptorchid testis: abnormal gubernacular attachment. 
Various factors are involved in testicular descent, and no single factor is elucidated as the cause of cryptorchidism.  We prospectively observed the locations of gubernacular attachments in the cryptorchid testis.  From April 1996 to June 2002, 639 boys underwent surgical correction of cryptorchid testis.  Those with complete records of testicular locations and gubernacular attachments were analyzed.  A total of 639 boys underwent 732 surgical corrections of inguinal testis (425, 58%), high scrotal testis (165, 23%) and impalpable abdominal testis (142, 19%).  Impalpable abdominal testes had gubernacular attachment to either the lateral or upper scrotum in 36 cases (25%) or around the inguinal ring in 83 (58%).  The gubernaculum was attached to the bottom of the scrotum in 21 inguinal testes (5%), to the lateral or upper scrotum in 132 (31%) or around the inguinal ring in 268 (63%).  In cases of high scrotal testis the gubernaculum was attached usually to the bottom of the scrotum (28, 17%), to the lateral or upper scrotum (109, 66%) or around the inguinal ring (26, 16%).  The locations of distal gubernacular attachments in the cryptorchid testis were usually abnormal (93%).  In these cases the possible testicular descent induced by hormonal therapy may either be insufficient or unable to prevent future ascent.  Thus, early surgical correction rather than hormonal therapy is warranted in boys with cryptorchid testis.