男子性器結核の臨床統計的観察 (シンポジウム: 尿路性器結核の昨日・今日・明日 第22回日本泌尿器科中部連合地方会 )

Abstract

Clinical statistics of the male genital tuberculosis during the past 10 years (1961-1970) in Japan were studied. The incidence of genital tuberculosis increased significantly since 1922, reached its peak in 1946-1949 (6.6% of the outpatients) after World War II. After that, it tended to decrease gradually and recently it is only 0.4%. The decrease of incidence of the disease is thought to be related to the chemotherapy. The diseased side was unilateral in 72.7% in the epididymis and bilateral in 47.1% in the seminal vesicles. More than 2 genital organs were invaded in 24.4%. Combination of operation and chemotherapy were mostly given for epididymis and chemotherapy played the chief role in the treatment of other cases. As chemotherapy, the combination therapy of SM, PAS and INAH was done in most cases. The administration periods ranged 6 months to 2 years when chemotherapy was combined with operation and 1 to 2 years or more when chemotherapy was given alone. The follow-up studies were made on 139 patients in the Gifu and Nagasaki University Hospitals. The combination of operation and chemotherapy showed the best result, however there was no significant difference between the operative and non-operative groups. The opposite side of epididymis was invaded in 16.0-18.4% after the treatment. Sixty to 70% of the patients had normal sexual function, 26 to 35% had decreased sexual potency, about 8% were impotent and 27.6% had no ejaculation. The severity of sexual dysfunction was high in patients with tuberculous lesions in more than 2 genital organs. Even in the unilateral cases the wives of the patients never conceived in 50.9-69%. With the progress of chemotherapy the prognosis in general condition of the patient with genital tuberculosis has markedly improved, however some problems of sexual function still remain unsolved. It is important to protect the opposite side of the genital organ from invasion of disease by removing the diseased epididymis earlier and to cure remaining changes in the seminal tract by further long-term chemotherapy.