FIGURE 1 : Gross anatomical view of penile variant of Mondor ’ s disease showing thrombosis of the dorsal superficial penile vein
FIGURE 2 : Ultrasonic view of thrombus of the dorsal superficial penile vein sexual activity . 2 , 4-5 , 8 , 10 Additionally , injury to the endothelium can occur as a result of intravenous drug abuse or sexually transmitted infections . 2 , 10 Hemostasis has been observed in patients with venous compression secondary to tumor overgrowth , bladder distension , penile strangulation , and the habitual use of restrictive waist accessories ( e . g ., belts ). Further implicated etiologies include prolonged standing and sustained abstinence from sexual activity . Hypercoagulability can be appreciated in patients with malignancy ( i . e ., paraneoplastic syndromes or metastatic disease ), sickle cell crisis , migratory thrombophlebitis ( Trousseau syndrome ), septic thrombophlebitis , coagulopathies , and following prostate biopsy . 2 , 10
There is a current lack of consensus on the treatment of PVMD ; however , a review of the literature recommends treatment be paired with the patient ’ s clinical course . The acute phase , generally thought to occur within the first 24 hours , is an acute thrombophlebitis and presents with pain and possibly fever . Treatment involves anticoagulants , anti-inflammatories , and possibly antibiotics . The subacute phase typically extends from four to six weeks but has been known to persist for up to eight weeks . 2 , 4 , 5 , 10 Inflammatory symptoms gradually evolve into vein induration , giving a smooth , cord-like appearance . Non-steroidal anti-inflammatory medications and topical heparin have been found to be useful during this phase . Recanalization should occur between six to eight weeks ; however , if it does not , PVMD is said to be entering a more chronic phase and may require surgical thrombectomy , where the resultant clot exhibits a mixture of red blood cells , platelets , fibrin , and leukocytes on histology . 5
Given that the overall pathophysiology of PVMD is a superficial thrombophlebitis , understanding the aspects of Virchow ’ s Triad is essential to identifying the underlying cause . Endothelial damage of the superficial dorsal penile vein has been most commonly attributed to the stretching or buckling forces of aggressive or prolonged
Our patient ’ s thrombosis persisted for nearly five months , much longer than currently reported in the literature , despite a two-week treatment course with anticoagulants and no discovered coagulopathy . Throughout that time , he remained good-natured and confident in his physician ’ s management plan . Fortunately , the administration of anticoagulants ultimately prevented surgical intervention and the patient was able to resume his intimate marital activities .
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