Penile Mondor’s disease

Dear Editor, To our knowledge, here, we report the Wrst penile Mondor’s disease (superWcial penile vein thrombosis), an extremely rare complication of inguinal hernia repair, in the English language literature. As over 800,000 inguinal hernia operations annually are performed in the USA, surgeons must be aware of the clinical presentation, diagnosis, and treatment options for this self-limited, benign disease. A 32-year-old male with right-sided inguinal hernia was admitted to our hospital for hernia repair. He was a hardworking mechanic. He had no thromboembolic event or hematologic disease before. On physical examination, he had an indirect reducible inguinal hernia and his preoperative blood tests were normal. We performed Lichtenstein hernia repair under local anesthesia with day-surgery setting and he was discharged uneventfully on the same day. On the seventh postoperative day, he was readmitted with painless cord-like induration on the dorsal surface of the penis and pain during erection. He had Wrst sexual intercourse on postoperative day 5 and denied any penile trauma. Physical examination revealed subcutaneous cordlike induration of the superWcial dorsal penile vein with inXammatory signs but without any sign of venereal infection or inguinal lymphadenopathy. Penile Mondor’s disease was conWrmed by the presence of thrombosis and the absence of venous Xow of the superWcial penile vein on color Doppler ultrasonography. He was treated with the non-steroidal anti-inXammatory drug (NSAID; diclofenac potassium 100 mg bid, p.o) and organo-heparinoid gel (bid, topical) for 2 weeks, and recommended to avoid sexual intercourse and not to wear a tool belt. He was totally asymptomatic and Doppler ultrasonography conWrmed recanalization of the superWcial dorsal penile vein at the end of the fourth week. Henri Mondor reported the Wrst superWcial vein thrombosis localized to the thoracoepigastric vein in 1939 and Braun-Falco described penile vein participation in 1955 [1, 2]. Afterwards, isolated superWcial penile vein thrombosis was Wrst described by Helm and Hodge in 1958 [2]. Penile Mondor’s disease, with an incidence of 1.39%, is a rare but also underdiagnosed disease, mostly published as case reports in the literature [3, 4]. Clinical presentation is characterized as the sudden onset of painless/seldom painful, cord-like induration, and localized inXammatory signs of the dorsal surface of the penis. The pathogenesis of penile Mondor’s disease is controversial: several predisposing factors, namely, penile trauma, excessive sexual intercourse, infection, pelvic surgery, intravenous drug injection, and prolonged venous compression due to a distended bladder, tumoral mass, sexual devices, or the use of tool belts. Furthermore, hypercoagulability disorders, such as the deWciency of protein S, protein C, and antithrombin III, are risk factors for penile Mondor’s disease [1, 2, 4]. BrieXy, all of the above-mentioned predisposing factors inXuences Virchow’s triad: vessel wall damage, stasis, and hypercoagulability [4]. With regard to diVerential diagnosis, sclerosing lymphangitis and Peyronie’s disease must be considered [4]. Sclerosing lymphangitis is a noninfectious acute cord-like lymphangitis of the coronal sulcus; however, the overlying skin is uninvolved and poses no erosion or ulceration. Though the etiology of sclerosing lymphangitis J. Kutlay · V. Genc · C. Ensari Department of Surgery, DÂokapÂ Teaching and Research Hospital, Ankara, Turkey