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Introduction: Thrombophlebitis of the superficial dorsal vein of the penis, known as Mondor’s disease of the penis, was first described by Braun-Falco in 1955.
Case Presentation: An apparently healthy 37-year-old man presented with painful swelling of the dorsal aspect of his penis. Doppler ultrasonography revealed a noncompressible portion of superficial dorsal vein of the penis, as well as the lack of venous flow signals. The patient was treated conservatively.
Conclusion: Mondor’s disease of the penis is a rare clinical entity and a urologist should be aware of this condition.
Kapil Singla, Ashish Kumar Sharma, Sistla Bobby Viswaroop, Ganesh Gopalakrishnan, Sangam Vedanayagam Kandasami
Department of Urology, Vedanayagam Hospital, Coimbatore, Tamil Nadu, India
Submitted: October 19, 2011
Accepted for Publication: November 23, 2011
KEYWORDS: Mondor’s disease; Superficial thrombophlebitis; Conservative management
CORRESPONDENCE: Kapil Singla, Department of Urology, Vedanayagam Hospital, Coimbatore, Tamil Nadu, India 641 002 ().
CITATION: UroToday Int J. 2012 Feb;5(1):art 87. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.05
Superficial-vein thrombosis was first described by Mondor in 1939 when it involved subcutaneous veins of the anterolateral thoracoabdominal wall . The most commonly involved vessel is the thoracoepigastric vessel. In 1955, Braun-Falco described penile participation, and, in 1958, Helm and Hodge described an isolated, superficial penile vein thrombosis [2,3]. Mondor’s disease of the penis is an under-reported condition. Although it is rare, proper diagnosis and consequent reassurance can help to dissipate the anxiety experienced by patients with the disease. This case report describes the symptomatology, diagnosis, and treatment of thrombosis of the superficial dorsal vein of the penis.
A 37-year-old man presented with a painful dorsal induration of the penis for 4 days. The pain was of the throbbing type. There was no associated itching, discharge, hematuria, fever, or dysuria. He denied any history of recent trauma, vigorous sexual activity, or use of constriction devices. He also denied any history of fever or lower urinary tract symptoms. A physical examination revealed a physically healthy man with a tender, cord-like swelling on the dorsal surface of the penis, which was extending from the glans penis up to the suprapubic area (Figure 1). There was no associated inguinal lymphadenopathy. Routine blood tests and the coagulation profile were normal. Doppler ultrasonography of the penis revealed a noncompressible, superficial dorsal vein, as well as the lack of venous flow signals (Figure 2). Provisional diagnosis of thrombosis of the superficial dorsal vein of the penis was made, and conservative treatment was prescribed in the form of heparin ointment, as well as nonsteroidal anti-inflammatory drugs (aceclofenac). The patient was advised to abstain from sexual activity and was advised to review at 1 month. On his first follow-up visit at 1 month, his physical examination revealed a complete resolution of the swelling. A repeat Doppler ultrasonography demonstrated restoration of normal blood flow in the dorsal vein (Figure 3).
Mondor’s disease of the penis is an uncommon disease that usually involves the superficial dorsal veins. In 1939, Henri Mondor first described a sclerosing thrombophlebitis of the subcutaneous veins of the anterior chest wall, and, in 1955, Braun-Falco described phlebitis of the dorsal veins of the penis within the context of generalized phlebitis [1,2]. Isolated penile Mondor’s disease was first described in 1958 by Helm and Hodge . Mondor’s disease is a benign and, usually, self-limited process. Patients complain of cord-like indurations, which are often painful, on the dorsal aspect of the penis, and this pain can be constant or episodic. The etiology of this condition is usually unknown. Many predisposing factors can lead to the development of thrombosis of the dorsal vein of the penis. These factors all relate back to Virchow’s triad of endothelial injury, stasis, and a hypercoagulable state. Various causative factors are there; e.g., penile trauma, excessive sexual activity, prolonged sexual abstinence, infection, pelvic tumors, and the constrictive elements used during certain sexual practices. Of these factors, the trauma caused by sexual intercourse appears to be the main etiologic factor. This may be due to stretching and torsion of the penile veins, causing endothelial denudation and the subsequent release of thromboplastic substances that can activate the coagulation cascade . Furthermore, Mondor’s disease of the penis has also been reported after long-haul flights , as an unusual manifestation of metastatic pancreatic adenocarcinoma, and as an idiopathic condition. The diagnosis of the disease is mainly clinical, supplemented with Doppler ultrasonography . The differential diagnosis includes sclerosing lymphangitis, Peyronie’s disease, and a fractured penis . Treatment is essentially conservative. Several methods of treatment have been proposed for penile Mondor’s disease. Anticoagulation with aspirin, heparin, or other antiplatelet agents will not expedite healing and is not necessary to prevent additional thrombosis. Antibiotics can be used prophylactically. NSAIDs can be used for pain relief, as well as for their inflammatory action. Patients should also be informed about the avoidance of sexual intercourse or masturbation. In most of the cases, symptoms resolve completely within 6 to 8 weeks. In cases with no resolution, despite conservative treatment, thrombus excision or excision of the vein has to be done . Such surgeries can relieve pain and diminish skin induration, and produce aesthetically pleasing results.
Dr. S Boopathy Vijaya Raghavan (Consultant Radiologist)
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