Evaluation and Treatment of Penile Thrombophlebitis (Mondor’s Disease)

Abstract

Superficial penile thrombophlebitis or penile Mondor's disease (PMD) is an underreported condition that causes anxiety and embarrassment in affected men. Patients usually present with a smooth, cord-like induration on the dorsal penile shaft 1-7 days after prolonged or intensive sexual intercourse, but other presentations of disease and triggers for endothelial damage are possible. The condition is typically self-limited with expected spontaneous resolution within 4-8 weeks of initial presentation, and absolute diagnosis is usually not necessary with management including supportive care and pain control. However, when disease course is prolonged or there are concerning risk factors, it may be important to differentiate PMD from other conditions such as Peyronie's disease, hypercoagulability, blood stasis, genitourinary infection, and malignancy. History and physical are often sufficient to distinguish these conditions from PMD, but providers may employ ultrasound to assist with the diagnosis. If PMD does not spontaneously resolve, patients may be considered for thrombectomy, at which point histological analysis can confirm the diagnosis.

Mondor's Disease: A Review of the Literature

“…Previous reports of PMD assert an incidence of approximately 1.39%-a high risk-in men 20-40 years of age with no claims of pain ( 14 , 15 ). Studies have found that the risk factors of PMD fit Virchow's triad ( 14 - 17 ), as follows: vessel-wall damage due to vigorous sexual activity, vacuum erection device, penile trauma, etc.…”

“…Studies have found that the risk factors of PMD fit Virchow's triad ( 14 - 17 ), as follows: vessel-wall damage due to vigorous sexual activity, vacuum erection device, penile trauma, etc. ; blood stasis, such as prolonged erection (including with the use of a PDE5 inhibitor), prolonged sitting position, and bladder overdistension; and hypercoagulation, such as urogenital infection, prostate biopsy, and hematological disease ( 14 ).…”

“…The more important step after the diagnosis of MD is distinguishing between primary (idiopathic) and secondary (due to an underlying disease) types ( Table 2 ). On laboratory tests, patients with a hypercoagulative state should be screened for protein C deficiency, protein S deficiency, antithrombin III deficiency, factor V Leiden mutation ( 35 ), PT 20210A mutation, and systemic metastasis as well as the etiology of hyperviscosity syndrome, such as myeloproliferative disorders ( 14 ). Vasculitis and other vascular diseases should also be considered, such as thrombophlebitis migrans, Burger disease, Behçet disease, giant-cell arteritis, and polyarteritis nodosa ( 32 , 35 ).…”

Tromboflebitis superficial del pene: primer reporte de caso en el Hospital Universitario Nacional de Colombia y recomendaciones actuales de manejo

“…La tromboflebitis de la vena superficial del pene (Enfermedad peniana de Mondor), es una entidad rara y poco frecuente que afecta principalmente a hombres en etapa productiva de la vida (entre los 20 y 57 años). Para el año 2015, no se contaba con más de 50 casos descritos en la literatura mundial 6 ; actualmente sólo se dispone de una referencia suramericana 7 y no hay casos descritos en la literatura médica colombiana. En su patogénesis se ha postulado como eje central factores o condiciones que alteran el balance de la tríada de Virchow (ver ►Tabla 1).…”

“…El caso expuesto tuvo como detonante de la enfermedad un coito vigoroso, a la ecografía doppler de pene presentó los signos radiológicos clásicos para enfermedad peniana de Mondor, recibió manejo médico en la fase aguda -subaguda Tabla 1 Factores asociados con la aparición de la Enfermedad de Mondor (todos los factores afectan el balance de la tríada de Virchow -daño endotelial, estasis venosa, estado procoagulante) 3,6,19,21,23 de la enfermedad y de forma similar a las experiencias descritas en la literatura mundial alcanzó un desenlace clínico favorable ya que presentó resolución sintomática tras dos semanas de manejo conservador y en el seguimiento clínico ejecutado tras un mes de ocurrido el evento agudo no presentó alteraciones anatómicas o funcionales significativas.…”