Case Report
Penile Mondor’s Disease: A Case Report and Review of Literature
Mahavir Singh*, Satish Dalal, Tulit Chhabra and Chisel Bhatia
Department of General Surgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, India
*Corresponding author: Mahavir Singh, Department of General Surgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, H.No. 11/ 11 J UH Medical Campus PGIMS Rohtak, Haryana, India
Published: 10 Aug, 2017
Cite this article as: Singh M, Dalal S, Chhabra T, Bhatia
C. Penile Mondor’s Disease: A Case
Report and Review of Literature. Ann
Clin Case Rep. 2017; 2: 1416.
Abstract
Penile Mondor’s Disease (PMD), thrombophlebitis of the superficial dorsal vein of the penis is a rare, self-limiting, benign process having acute presentation with pain and induration of the dorsal part of the penis. Exact etiology of the disease is not known but prolonged sexual intercourse has been stated as the most common cause in the literature. A simple physical examination is sufficient for diagnosis but color doppler ultrasonography is often carried out as a further investigation. Proper diagnosis and consequent conservative treatment with reassurance can help the patients to relieve their anxiety. We describe the symptoms, the sonographic findings and treatment of a 29-year-old male with superficial thrombophlebitis of the penis dorsal vein.
Keywords: Penile; Mondor’s disease; Thrombophlebitis
Introduction
Mondor’s disease is thrombophlebitis of the superficial dorsal vein of the penis veins sometimes thrombophlebitis of the circumflex vein of the penis with sparing of the dorsal vein. It was first defined by Henri Mondor in the superficial veins of the chest wall in 1939 [1]. In 1955, Braun-Falco defined dorsal phlebitis of the penis as a part of generalized phlebitis [2]. Isolated thrombosis of the dorsal superficial vein of the penis was first reported and Penile Mondor’s disease was defined by Helm and Hodge in 1958 [3]. PMD is a rare and under-recognized benign genital condition and only < 100 cases have been reported in literature [4]. Its real incidence is considered to be higher than reported. The true incidence of Mondor's disease is unknown, but one series showed an incidence of 18 of 1296 (1.39%) patients in a sexually transmitted disease clinic over a 12-year period [5].
Case Presentation
A 29- year- old unmarried man presented to our hospital with a three days history of pain and
swelling on the dorsal side of the penis. Pain was felt more severe at the time of penile erection. There
was history of vigorous masturbation 5 days back. The patient otherwise denied trauma, dysuria,
hematuria, difficulty with erection, multiple sexual partners, or attempted intercourse. He had no
relevant past medical history. Physical examination revealed a well-developed male with no signs of
lymphadenopathy in the groin region and without any palpable hernias. Genitourinary examination
revealed an uncircumcised penis and a palpable cord on the right dorsal side of the penis (Figure 1). The overlying skin was completely intact with no erythema. Mild tenderness of the penile shaft was
noted and testicular exam revealed no swelling or pain on palpation. Urine microscopy, full blood
count, and coagulation studies were all within normal limits. On Doppler ultrasound a cord-like
non-compressible lesion containing internal echogenicity with no color filling and flow spectrum
around the coronal sulcus was detected (Figure 2). Doppler ultrasound of cavernosal arteries and veins were normal and the administration of vasoactive agent was thought to be unnecessary.
The patient was anxious and worried about his future sexual performance and fertility. Patient
was managed conservatively with reassurance, oral anti-inflammatory and anticoagulant aspirin
therapy and local application of heparin gel for a period of 2 weeks as a result of which the pain
subsided and induration disappeared. Now after follow up of 3 months there is no residual
induration and patient is totally assymptomatic with no erectile pain or dysfunction.
Figure 1
Figure 2
Figure 2
Doppler ultrasound findings include an increase in the diameter of
superficial dorsal vein, non-compressibility and thrombus in the superficial
dorsal vein.
Discussion
Penile Mondor’s Disease (PMD), thrombophlebitis of the superficial dorsal vein of the penis is a
rare, self-limiting, benign process having acute presentation with pain and induration of the dorsal
part of the penis [1]. Various causes of the disease that has been mentioned in the literatures include frequent, severe, and prolonged sexual intercourse, penile trauma,
prolonged sexual abstinence, local (e.g. syphilis, candida infections)
or distant infections, history of sexually transmitted diseases,
thrombophilia, repair of inguinal hernia, orchiopexy, varicoselectomy,
use of intracavernous drugs, use of vacuum, Behçet’s disease, body
building exercises, cancer in the pelvic region, metastatic pancreas
cancer and migratory phlebitides due to paraneoplastic syndromes,
venous occlusion caused by filled bladder, abuse of intravenous drugs,
and tendency to thrombosis [2-5]. Thus any of the components of
Virchow’s triad i.e. coagulation due to injury to vessel wall, stasis, and
hyper-coagulation can lead to the development of thrombosis of the
dorsal vein of the penis. But the main etiological cause is considered
to be trauma due to sexual intercourse. In present case there was
history of vigorous masturbation which might has caused injury to
the vessel wall.
The patients usually present with hardness like a rope at dorsum
of the penis. They complain of continuous pain and throbbing.
Sometimes erythema and edema may be seen on the penile skin.
Some patients feel distention on the site of thrombosis. There is
usually pain typically exacerbated during erection [6,7]. In present
case, presentation was with pain and swelling on dorsum of penis
with palpable cord. Important differential that should be considered
in the diagnosis of a painful, fibrotic lesion of the penis includes
sclerosing lymphangitis and Peyronie’s disease. However, sclerosing
lymphangitis is characterized by thickened and dilated lymphatic
vessels whose morphology is serpiginous. Peyronie’s disease results
from a thickening of the tunica albugenia and presents as a well
defined fibrotic plaque on the penis.
PMD can be diagnosed with medical history and physical
examination. The role of imagining in PMD is to identify the
intravascular thrombus. In case of doubt we may take the help of
Doppler ultrasound. Doppler ultrasound findings include an increase
in the diameter of superficial dorsal vein, non-compressibility and
thrombus in the superficial dorsal vein [8]. PMD is clinically divided
in three stages as acute, subacute-chronic and recanalization stages.
In this case report patient presented in acute phase. In the acute
stage, sexual activity should be restricted in addition to the use of
oral anti-inflammatory, anti-coagulant agents. This patient was
also managed conservatively with oral anticoagulant aspirin, antiinflammatory
drug Diclofenac sodium orally and local application of
anticoagulant heparin gel along with advice to avoid sexual activity.
Creams containing heparin and anti-inflammatory drugs are used in
the subacute and chronic stages in addition to restriction of sexual
activity. Most of the cases seen early respond well to conservative
treatment such as anti-inflammatory agents and anticoagulant and
antithrombotic drugs. These drugs reduce the recovery period. In
cases of infection antibiotics must be used. Most cases resolve in four
to six weeks and are recanalised by nine weeks. In persistent cases,
surgical treatment is recommended which include stripping of the
vein or thrombectomy.
In conclusion, PMD is a rare under-recognized benign genital
condition that every attending physician should be aware of this,
self resolving condition to prevent misdiagnosis and overaggressive
treatment with its attendant physical and emotional trauma.
References
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