Mondor's Disease of the Penis
Ali Al-Amiri (dr dot ali995 at hotmail dot com) #, Abdullatif Al-Terki, Tariq Al-Shaiji
Department of Surgery (Division of Urology), Amiri Hospital, Kuwait
# : corresponding author
DOI
//dx.doi.org/10.13070/rs.en.2.1454
Date
2015-09-02
Cite as
Research 2015;2:1454
License
Abstract

Introduction/Objective: Thrombophlebitis or thrombosis of the superficial dorsal vein of the penis also known as penile Mondor's disease is an unusual condition characterized by an abrupt redness and/or swelling of the dorsum of the penis accompanied by a palpable and mostly tender thrombotic vein. This condition can be idiopathic, may be caused by trauma or may follow vigorous sexual intercourse. Penile fracture and Peyronie's disease are the main differential diagnosis. The objective of this paper is to focus on the clinical presentation and management of this condition based on three cases encountered in our practice. Patients & Methods: Three patients presented with swollen superficial dorsal vein of penis in a sub-acute fashion. All the patients underwent penile ultrasound as part of their clinical work up. Result: Ultrasound examination of the penis showed superficial dorsal vein thrombosis in all 3 cases. All 3 cases were managed conservatively with reassurance, NSAID's at as needed basis and avoidance of sexual activities during the symptomatic phase. None of the patients required surgical intervention. When patients were re-evaluated after 4 weeks in the urology outpatient clinic, it was observed that all signs and symptoms had resolved without any negative sequelae in two patients. One patient had residual mild hardening of the vein which resolved during subsequent visits. Conclusions: Penile Mondor's disease is a benign condition of the penis. Although this condition is uncommon, urologists should be aware of its nature and consider it in the differential diagnosis of acutely swollen penis. It is usually managed conservatively.

Introduction

Thrombophlebitis or thrombosis of the superficial dorsal vein of the penis also known as penile Mondor's disease, is a rare condition characterized by abrupt redness and/or swelling of the dorsum of the penis accompanied by a palpable and mostly tender thrombotic vein. This condition can be caused by trauma, vigorous sexual intercourse, prolong abstinence and a distended bladder. Penile fracture and Peyronie's disease are the main differential diagnosis. In this paper we describe lessons learnt from the history, clinical examination, investigation and treatment of 3 cases in our clinical practice.

Case Presentation
Case 1

A 36 year-old male presented to urology OPD complaining of painful red swelling on dorsal aspect of the penis. The swelling appeared immediately after vigorous sexual intercourse one day ago. There was no history of trauma, sexually transmitted disease or similar presentation before.

On examination, he was healthy and without being in distress. Genitourinary examination revealed a cord-like tender superficial vein associated with erythematous skin changes.

Color doppler ultrasound (U/S) showed obstruction of the superficial dorsal vein of penis. Complete blood count (CBC) showed mild elevation of WBC (WBC = 12 109/L), otherwise liver function tests (LFT), and coagulation profile were normal.

The patient was treated with NSAID (Ibuprofen 400 mg BD) for 3 weeks and cefuroxime (500 mg BD) for 1 week. After 4 weeks, all symptoms and swelling resolved.

Case 2

A 44 year-old male, previously healthy, presented to the Casualty Department with cord–like induration of the penis associated with severe penile pain. He had a history of 3 episodes of vigorous sexual intercourse within the last 3 days.

Genitourinary examination revealed severe tender cord-like induration of superficial dorsal vein without any skin changes. CBC, LFT, and coagulation profile were normal. Color doppler U/S confirmed diagnosis of obstruction of superficial dorsal vein with no flow signal.

Because of severe pain, he was admitted to hospital for pain control and was discharged on the next day on NSAID (Ibuprofen 400mg BD) for 3 weeks and paracetamol tablets when necessary. After 3 weeks of follow-up, he was symptoms- free and the penile induration had resolved.

Case 3

A 28 year-old male, known case of hypertension, presented to urology OPD with painless rope-like thickening of penis for 12 days. There was no previous history of trauma, STD or recent sexual intercourse.

On examination the patient was healthy and not in distress. Examination of the penis showed a non-tender rope-like thickening of proximal two-third of dorsal penis with no skin changes. Color doppler U/S showed echogenic content within superficial dorsal vein without flow signal. The CBC, LFT, coagulation profile were normal.

The patient received NSAID (Diclofenac 50 mg TDS) for 3 weeks and the penile thickening disappeared.

Discussion

Thrombosis of the superficial vein of the chest wall was first described by Mondor in 1939 [1]. Isolated penile Mondor's disease was first described by Helm and Hodge in 1958 [2]. Mondor's disease of the penis is a benign condition that tends to affect males in different age groups (21-70 years) [3].

Disruption of Virchow's triad ( vessel wall damage, blood stasis or hypercoagulable state) is thought to be the main factor for this condition [4]. There are many reported causal factors, such as penile trauma, vigorous sexual intercourse, distended bladder, circumcision and pancreatic carcinoma [5].

To make the correct diagnosis of this condition, obtaining the correct medical history and physical examination are important. Patients will present with painful rope-like cord on the dorsum of the penis. Pain may be constant and associated sometimes with painful micturition [6]. Doppler U/S can be done to confirm the diagnosis by showing clot within the vein which will be distended and non-compressible and color Doppler often confirms the absence of flow within the vein. In addition, in some cases, the presence of low-flow, high resistance arterial wave forms in the cavernous artery might be suggestive of Mondor's disease [7].

Urologists should be able to differentiate between Mondor's disease of penis and other conditions, such as penile fracture, sexually transmitted disease, sclerosing lymphangitis and Peyronie's disease. Sclerosing lymphangitis is characterized by the presence of thickened, dilated lymphatic serpiginous vessels. Peyronie's disease results from thickening of the tunica albuginea and presents well-defined fibrotic plaque on the penis.

Abstention from sexual intercourse represents the most effective treatment modality. Anti-inflammatory drugs (NSAID) are used for pain relief and to diminish the inflammatory reaction. Some urologists like to use local dressing with anti-coagulant agent, such as heparin ointment, although there is no evidence to show that this has any therapeutic efficacy. Our experience together with those of others indicate that most cases of Mondor’s disease will resolve within 4-6 weeks with conservative therapy (3-5). In persistent cases, penile vein resection or thrombectomy can be done.

Conclusion

Penile Mondor's disease is a benign condition that is treated conservatively or, rarely by surgical intervention. Although this condition is uncommon, urologists should be able to differentiate Mondor's disease from other acute conditions affecting the penis like penile fracture, penile trauma, Peyronie's disease, sclerosing lymphangitis, lymphedema involving the penis.

References
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