Reply by Authors

We agree that the ideal strategy in patients withan SMT would be to follow them with periodic USand perform surgery only in those who show sig-nificant growth during followup. This is our actualpolicy in masses less than 5 mm in diameter. Inthis group few patients required surgical explora-tion during followup. It is likely that in cases ofsuch small lesions strict surveillance may notchange the progression of germinal tumors, as re-ported by Bieniek et al, who noted a mean lesiondiameter of 4.142.0 mm (reference 1 in EditorialComment).However, sparse data are available in the litera-ture on the natural history of larger masses whenleft untreated. Our study shows that even largerlesions up to 20 mm in diameter may be benign, indicating that strict surveillance might be justifiedeven for masses larger than 5 mm. Our experiencealso demonstrates that with increasing lesion sizethe risk of cancer significantly increases 7 times permm. This information could be used to bettercounsel patients about the risk of harboring TC andeventually better support a followup strategy inpatients with an STM.We believe that 2 research lines which might helpus in the near future are 1) study of the individuallesion growth rate, which could differentiate benignfrom malignant lesions, and 2) new imaging diag-nostic tests such as contrast enhanced US1ortesticular magnetic resonance imaging, whichmight improve the diagnostic performance of scrotalUS.