What is the management of penile Mondor's disease?

Management of Penile Mondor's Disease

Penile Mondor's disease should be treated conservatively with NSAIDs, abstinence from sexual activity, and reassurance, as it is typically a self-limiting condition that resolves within 4-6 weeks without long-term complications.

Definition and Clinical Presentation

Penile Mondor's disease is a superficial thrombophlebitis affecting the dorsal vein of the penis. It presents with:

• Cord-like induration along the dorsal penis
• Localized pain and tenderness
• Possible inflammatory changes
• No erythema typically present

Diagnostic Approach

The diagnosis is primarily clinical, based on the characteristic presentation of a palpable, cord-like structure on the dorsal penis. If there is uncertainty:

• Doppler ultrasound is the imaging modality of choice 1
• Ultrasound findings include:
  • Hyperechoic thrombosis in the superficial dorsal penile vein
  • Dilation of the affected vein
  • Absence of blood flow in the thrombotic segment 2

Treatment Algorithm

First-Line Management (Conservative)

1. NSAIDs for pain control and anti-inflammatory effect

   • Example: Nimesulide 100 mg orally twice daily for 2-3 weeks 3

2. Sexual abstinence

   • Advise patients to abstain from sexual intercourse and masturbation until complete resolution 3

3. Reassurance

   • Explain the benign and self-limiting nature of the condition
   • Typical resolution occurs within 4-6 weeks with conservative management

Second-Line Management

For cases that don't respond to conservative treatment after 4-6 weeks:

1. Anticoagulation therapy
   • Low molecular weight heparin (LMWH) at prophylactic or intermediate doses for 4 weeks 4
   • Example: Enoxaparin 1 mg/kg daily for 30 days

Third-Line Management (Rare)

For persistent cases with significant symptoms despite medical management:

1. Surgical intervention
   • Thrombectomy with resection of the affected superficial dorsal vein 5
   • Reserved for cases that fail to respond to conservative and anticoagulant therapy

Etiology and Risk Factors

Common precipitating factors include:

• Trauma to the penis
• Excessive sexual activity
• Prolonged sexual abstinence
• Recent pelvic or genital surgery
• Prolonged use of sildenafil (potential association) 2
• Malignancy (rare but should be considered in persistent cases)

Follow-up and Monitoring

• Clinical assessment after 2-3 weeks to evaluate response to treatment
• If symptoms persist beyond 6 weeks, consider:
  • Reassessment with Doppler ultrasound
  • Evaluation for underlying conditions
  • Consideration of anticoagulation or surgical options

Important Considerations and Pitfalls

1. Avoid unnecessary invasive procedures

   • The condition is self-limiting in most cases
   • Surgical intervention is rarely needed

2. Address psychological impact

   • Patients often experience anxiety about potential sexual dysfunction
   • Proper reassurance can prevent anxiety-induced erectile dysfunction 3

3. Rule out other conditions

   • Peyronie's disease (presents with plaque formation and penile curvature)
   • Penile fracture (acute onset after trauma with "popping" sound and immediate detumescence)
   • Sclerosing lymphangitis (involves lymphatic vessels rather than veins)

4. Consider thrombophilia workup

   • In recurrent cases or those with personal/family history of thrombotic events 4

By following this approach, most cases of penile Mondor's disease will resolve completely without long-term complications or impact on sexual function.