Demographics
1.4 % of the population Male gender Predominately 20 to 40 years old
Risk Factors Endothelial Damage
Aggressive sexual activity IV drug abuse Sexually transmitted diseases
Signs and Symptoms
Erythematous , warm cord Located at the dorsum of thw penis Pain is variable ( worse with erections )
Diagnosis
TABLE 1 : Penile Variant of Mondor ’ s Syndrome Summary
Hemostasis
Bladder distension Penile strangulation Restricitve waist accessories Tumor compression
Clinical exam is often sufficent Ultrasound can help confirm the diagnosis Coagulopathy work-up to identify underlying disorder Biopsy should only be undertaken if diagnosis is inconclusive MRI / MRA can help exclude pelvic extensions
Management Acute Phase
First 24 hours Symptomatic Treatment NSAIDs Anticoagulants * Antibiotics *
Subacute Phase
4 to 8 weeks Symptomatic Treatment NSAIDs Topical Heparin
* These are not proven treatments .
2 , 4 , 5 , 8 , 9 , 10 . 11
* IV : Intravenous ; NSAIDS : Non-steroidal anti-inflammatory drugs .
Coagulopathy
Genetic coagulopathies Malignancies Migratory thrombophlebitis Prostate biopsy Septic thrombophlebitis
Beyond 8 weeks Trombectomy
Chronic Phase at rest , only with erections , or not occurring at all . 9 The diagnosis of PVMD is usually clinical , based on the patient ’ s presentation , history , and physical examination . An ultrasound can be useful in ascertaining the diagnosis of PVMD and aid in the exclusion of other possibilities . 2
The condition most commonly confused with PVMD is non-venereal sclerosing lymphangitis of the penis ( NVSL or NSLP 12 ). However , the dorsal , firm , and straight cord of PVMD distinguishes this condition from the pliable , translucent , serpiginous rash of NVSL / NSLP . 5 If clinical diagnosis remains inconclusive , biopsy can then be pursued . Plump vascular endothelial cells staining positive with CD31 and CD34 2 or FV111-
RAG 13 should histologically differentiate lymphatic pathology from the venous clot . Another confounding diagnosis can be the fibrous plaque found in patients with Peyronie ’ s disease . However , in this instance , the fibrous plaque tends to be located more distally on the shaft of the penis and effects its shape when erect . Diagnosis of PVMD can be aided by ultrasound , which shows increased resistant flow of the cavernosal artery with color flow imaging . 2 , 5 , 10 Magnetic resonance imaging / magnetic resonance angiography may be helpful , particularly given the need to exclude pelvic extensions . 14
Comprehensive knowledge of PVMD diagnosis and management requires familiarity with the vascular anatomy of the penis ( Figure 3 ). Penile vasculature is divided into separate compartments by fascial layers . 2 , 5 Venous drainage of the penis begins within the venous canals at the base of the glans , which then merge into the dorsal vein . In the distal two-thirds of the penis , a series of up to 10 circumflex veins originate in the corpus spongiosum , extending circumferentially around the corpus cavernosa , merging into the deep dorsal vein and then continuing into the peri-prostatic plexus . 2 , 5 , 8 The superficial dorsal penile vein drains the prepuce , skin , and subcutaneous tissues , eventually leading to the superficial external pudendal vein and the long saphenous vein . 2 , 10
West Virginia Medical Journal • June 2021 • 41