1918 Journal of the American Medical Association (JAMA)  
an exact knowledge of its pathology and mode of invading the various structures of the body is most important. In the case of tuberculosis of the male genitalia such exact knowledge is in some respects lacking; especially in regard to the structures primarily attacked by this disease. At the present writing, the majority opinion holds that the first structure to become involved in the tuberculous process is the epididymis, and that from this the disease quickly spreads to involve the vesicle
more » ... prostate. A smaller number of investigators feel that the disease begins its genital invasion in the prostate, spreading from there to the vesicles and epididymis. This is a question which has long been argued, and is of much more than mere academic importance, because only by eradicating the primary focus may we expect the greatest number of cures. In accordance with this majority opinion, that the tuberculous process begins in the epididymis, the operation of removal of this structure has been widely employed and in some instances has undoubt¬ edly been followed by excellent results. By the opera¬ tion, not only is the suppurating or tender focus in the scrotum disposed of, but also further disease either in the testis, or in the prostate and seminal vesicle may become quiescent. But that such a fortunate result cannot always be expected, and that our attempts to cure tuberculosis of the male genital tract by epididymectomy thus far leave much to be desired may be easily seen from the statistics collected by many surgeons. To mention two writers, Keyes1 says, in speaking of tuberculosis of the testicle, "Relapse on the opposite side almost inevitably occurs." And from his table, it may be seen that, of fifty-three relapses in the other epididymis, forty-six had occurred within one year after operation on the side primarily diseased. Barney2 says : It is a characteristic of the disease to attack the opposite epididymis in over one-half the cases, within a year or two of the time of involvement of the first side. This catastrophe occurs in spite of all efforts to prevent it, but early excision of the epididymis first attacked will improve the chances for the escape of its fellow. Results such as these are hard to explain if we assume that the disease process is primary in the epi¬ didymis. On the other hand, they are easily explained if we consider the prostate and vesicles to be the point of first attack. If this assumption is made, it is evident that the focus nearer the center, untouched by the removal of the epididymis, is still present, ever ready to involve the second epididymis in the same manner as it did the first. In what percentage of cases of tuberculosis of the epididymis are the prostate and vesicles free from this disease? It is evident that in the answer to this ques-From the
doi:10.1001/jama.1918.02600480006003 fatcat:jbwafyc6xveyjfgxnbivvzigai