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Diffuse swelling of the penis in a young adult

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Q1: What is the probable diagnosis?

Mondor's disease of the penis. It is thrombophlebitis of the superficial dorsal vein of the penis.

Q2: What is the aetiology and pathology of this condition?

The main cause of the disease is frequent or prolonged intercourse. Other causes are enumerated in box 1. Thrombophlebitis of the superficial dorsal vein of the penis is a benign disease. Clinical and experimental evidence from previous reports suggests that stretching and torsion of the vein resulting from genital trauma leads to endothelial damage and thrombosis. Thrombophlebitis of the superficial dorsal penile vein can be divided into three clinical stages: acute, subacute, and chronic.

Box 1: Common causes of penile Mondor's disease

  • Repeated sexual intercourse

  • Trauma to penis

  • Infection

  • Penile intravenous drug abuse

  • Idiopathic

Q3: How can this condition be managed?

The majority of the cases of Mondor's disease of the penis are treated conservatively. The acute stage has been treated in a variety of ways with anti-inflammatory agents, anticoagulant drugs, and antibiotics with good results. For subacute and chronic stages, most have used anti-inflammatory agents and local heparin creams. Most cases resolve in four to six weeks. It is important that the patient should avoid sexual intercourse during medical treatment. In persistent cases, either penile vein resection or thrombectomy has been recommended. The prognosis is good. There are no reports of erectile dysfunction or penile deformity after treatment.

Discussion

Superficial venous thrombosis of the chest wall was first reported by Mondor in 1939.1 It was described in the penile veins by Braun-Falco in 1955.2 Isolated superficial dorsal vein thrombosis was reported in 1958 by Helm and Hodge.3Mondor's disease of the penis is a benign condition. Sexual intercourse should be considered as the main aetiological factor.4 Patients present with cord like induration on the dorsal surface of the penis. Pain may or may not be present. Swelling of the penis due to oedema is seldom present. It can present as an acute thrombophlebitis in which case pain and fever are often associated with significant inflammation of the penis. Diagnosis is obvious on clinical examination. Colour Doppler ultrasonography4 is an important tool in the diagnosis and follow up of these patients to visualise resolution of the thrombus and restoration of normal blood flow. 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.4 In persistent cases, surgical treatment is recommended—for example, stripping of the vein or thrombectomy.5 Surgical treatment in these advanced cases is very effective for relieving pain, decreasing skin induration, and producing aesthetically pleasing results. There have been no reports of deformity of the penis or impotence after treatment.

Final diagnosis

Mondor's disease of the penis.

Learning points

  • Mondor's disease of penis is a benign condition.

  • Trauma from prolonged or frequent sexual intercourse is the commonest cause.

  • Sudden and painful or painless cord like induration on the penile dorsal surface is the commonest presentation.

  • Doppler ultrasonography is helpful in both diagnosis and follow up.

  • Medical treatment and, when indicated, vein resection are successful.

References

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