Rigi10™ Malleable Penile Prosthesis
Also Known As
Penile superficial thrombophlebitis, Mondor's phlebitis of the penis, Superficial dorsal penile vein thrombosis, Circular indurated lymphangitis, Non-venereal sclerosing lymphangitis of the penis, Benign transient lymphangiectasis, Localized lymphedema of the penis, Mondor cord of the penis.<sup>3</sup>
Definition
Penile Mondor’s Disease (PMD) is a rare and benign clinical condition characterized by thrombophlebitis, which is the inflammation and clotting of a superficial vein, specifically affecting the dorsal vein of the penis.1 It typically presents as a palpable, firm, cord-like subcutaneous band along the shaft of the penis.1˒3 While generally considered a form of superficial venous thrombosis, some research also suggests a possible lymphatic origin.1 The condition is usually self-limiting, meaning it resolves on its own over a period of weeks to months.1˒3 Its primary purpose in urology is as a diagnostic entity to be recognized, differentiated from more serious conditions, and managed appropriately to alleviate patient anxiety and discomfort, even though it typically does not require aggressive treatment.1
Clinical Context
Penile Mondor’s Disease is typically encountered in sexually active men, with reported ages ranging from 18 to 70 years, though it classically affects men under 45.1˒3 The condition often presents acutely, with patients noticing a firm, rope-like lesion on the dorsal (top) or dorsolateral aspect of the penis.1 Symptoms can include localized pain, tenderness, and discomfort, which may be exacerbated during an erection.1˒3 Some individuals may experience overlying skin erythema (redness) or edema (swelling).1 However, a significant number of cases can be asymptomatic.3
The primary trigger for PMD is often considered to be trauma to the penile veins, most commonly associated with vigorous or prolonged sexual intercourse or masturbation.1˒3 Other potential etiological factors include protracted sexual abstinence, local infections (e.g., syphilis, candida), a history of sexually transmitted diseases, thrombophilia (an increased tendency to form blood clots), direct penile trauma, use of constrictive devices or vacuum erection aids, and rarely, it can be associated with pelvic surgeries, pelvic cancers, or systemic conditions like Behçet’s disease.1˒3 The pathogenesis is thought to involve Virchow’s triad: endothelial injury to the vein, stasis of blood flow, and a hypercoagulable state.1
Diagnosis is predominantly clinical, based on the characteristic history and physical examination findings.1 A palpable cord-like structure is the hallmark sign. Color Doppler ultrasonography can be a valuable diagnostic tool to confirm the presence of thrombosis (a blood clot within the vein) and the absence of blood flow within the affected segment, and to differentiate PMD from other conditions such as Peyronie’s disease, sclerosing lymphangitis, or infections.2˒1
Patient selection for any intervention is minimal as the condition is benign and self-limiting in most cases.1˒3 Reassurance and education about the benign nature of the disease are crucial components of management. Expected outcomes are generally excellent, with spontaneous resolution typically occurring within 4 to 8 weeks, although it can sometimes take longer.1˒3 Conservative management is the mainstay of treatment. It includes sexual rest, avoidance of activities that may traumatize the penis, warm compresses, and analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief.1 In rare persistent or particularly symptomatic cases, surgical excision of the thrombosed vein segment has been described, but this is not commonly required.3