Penile Mondor's Disease: Two Rare Cases

Abstract

Cases:A 55-year-old male complained of a five day history of a firm, painful, cord-like area on his penis. Physical exam was significant for a palpable, hard, serpiginous cord on the dorsal shaft. Ultrasound of the cord showed thrombosis of the penile vein. Similarly, a 27-year-old male complained of a one month history of a painful bump on his penis. Physical exam was significant for a firm, painful cord over the dorsum of the penile shaft. Discussion:Both patients had penile Mondor's disease (PMD). Penile Mondor’s disease is defined as a superficial thrombophlebitis of the penile dorsal vein. Although the most common cause of PMD is trauma due to frequent and prolonged sexual intercourse, other risk factors include infections, surgery, cancer, and Virchow's triad.The typical PMD patient is a 20 to 40-year-old male who presents with a firm, cord-like lesion on the dorsum of the penis 24 to 48 hours after prolonged sexual activity. The thrombosed vessel is often adherent to the overlying skin, and the thrombosis can extend to the suprapubic region. Patients may complain of continuous throbbing pain or pain exacerbated by erection. Color doppler ultrasound is necessary to confirm the diagnosis; it will show occlusion of the dorsal vein and absent flow signals. Color doppler ultrasound will also differentiate PMD from sclerosing lymphangitis of the penis and Peyronie's disease. Treatment includes anti-inflammatory agents and restriction of sexual activity. Patients often recover within four to six weeks and regain vessel permeability within two months.

Mondor Disease - An Underdiagnosed Pathology: Case Report and Review of Literature

“…Antibiotics should only be used when there is infection associated. [1,2,5] Our patient received expectant management, with a resolution of his symptoms by the 6 th week. However, surgical management (thrombectomy or superficial dorsal vein removal) should be consider in patients with recurrence or refractory pathology, defined as the persistence of symptoms or absence of venous flow after 6 weeks of initial treatment.…”

“…In 1955 it was designated in the veins of the penis by Braun Falco and finally 3 years later was reported in the superficial dorsal vein of the penis by Helm and Hodge. [3][4][5] Mondor disease is often seen in men between 20 and 70 years old, with an incidence of 1.39% and a prevalence of 1.4%. [1,2] Its believed that many cases are undiagnosed because patients fear or are ashamed of their condition, thinking something bad happened to them, therefore, not seeking medical care.…”

“…The findings in the ultrasound are absence or low venous return, the presence of a thrombus (hypoechogenic material) which leads to a not compressible vessel, low peak systolic velocity, and an increase resistant index in the cavernous artery. [2,5,6,8] This undiagnosed entity has two main differential diagnosis, sclerosis lymphangitis and Peyronie disease. Sclerosis lymphangitis is characterized by big and dilated lymphatic vessels which can be seen on color Doppler ultrasound with the preserved venous flow, whereas, Peyronie disease is portrayed by an abnormal curvature of the penis which is evident during a physical examination.…”

“…Palpation reveals fibrotic plaques in the dorsal surface of the phallus and the ultrasound is with no evidence of thrombus. [2,5,8] Mondor disease is a self-resolving process; therefore, treatment should be expectant management, achieving restauration of blood flow within 6 weeks in >90% of the cases. During the first two stages of the disease, treatment should be sexual abstinence for 6 weeks, oral, and/or topical nonsteroidal anti-inflammatory drugs, heparin unguents or topical corticosteroids.…”

“…However, surgical management (thrombectomy or superficial dorsal vein removal) should be consider in patients with recurrence or refractory pathology, defined as the persistence of symptoms or absence of venous flow after 6 weeks of initial treatment. [5,8] Nowadays is important that patients are able to receive education about this disease sincethe anxiety the it can generate is huge and can affect their sexual performance, leading to erectile disfunction and decrease in the International Index of Erectile Function, thus, is very important to ensure is a benign, self-resolving condition. [1,2,5]…”