Penisin Yüzeyel Dorsal Ven Trombozunun Retrospektif Analizi
Abstract
Giriş: Penil yüzeysel venöz tromboz nadir ve az bilinen iyi huylu genital
durumdur; literatürdeki en geniş olgu serileri 25 ve 30 hastayı
tanımlamaktadır.
Gereç ve Yöntemler: Ocak 2009 ile Ocak 2018 arasında üroloji
polikliniğinde penil mondor hastalığı (PMH) tanısı ile tedavi ve takibi yapılan
23 hastanın verileri retrospektif olarak değerlendirildi. Hastalar için
anamnez, yüzeyel ven renkli doppler ultrasonografi ve rutin laboratuvar analiz
(kan sayımı, elektrolitler ve pıhtılaşma testleri) uygulandı. Seküel aktiviteden
kaçınma NSAID, anti-koagülan ajanlar ve topical Arnica montana kullanımını
içeren konservatif yaklaşım uygulandı. Tedavinin 1. hafta ve 3., 5., 8.
haftalarında ve 3. ayda takip muayeneleri yapıldı. Klinik iyileşme
değerlendirildi.
Bulgular: Çalışmamızda hastalarımızın ortalama yaşı 42.4 (SD:11.12) medyan yaşı 44,
yaş aralığı 22 ile 66 aralığındaydı. Hastaların BMI 28.5 (SD: 2.48) ve aralığı
22.91 ile 34.31 idi. Hastaların semptomlarının başlangıcı ve kabulleri arası
süre ortalama 9.35 (SD: 13.42) medyanı 4 gün olup semptomlarının başlangıcı ve
kabulleri arası en az süre 1 gün en uzun süre 60 gündü. Hastalarımızın tamamı
peniste ağrısız palpable kord semptomu ile kliniğimize başvurmuştu.
Hastalarımızın 20'sinde tromboze damar dışardan belirgindi. Tromboz çapı
ortalama 3.09 ± 1.04 mm ve medyanı 3 mm (dağılım 1.8-5) idi. Tıkalı damarların
çapı 1.3 ile 4.7 mm arasında değişiyordu. Standart labaratuvar testleri
normaldi. 8 hastada lezyonların koronal sulkusun hemen altında sulkusa paralel
sert lezyon olduğu (video) ve diğer 15 hastada dorsal peniste cord-like lezyon
olduğu görüldü (resim). Venöz renkli doppler ultrasonografi sonuçları tüm
hastalar için benzerdi. Doppler ultrasonografide yüzeyel venin lümeninde renk
dolgusu ve akış spektrumu gözlenmedi. Etyolojide 8 hastada uzamış cinsel
aktivite, 5 hastada uzamış mastürbasyon, 3 hasta da vakum erreksiyon cihazı, 7
hasta idiopatik izlendi. Hastaların sadece birinde daha önce PMH öyküsü
gelişimi mevcuttu. Konservatif tedavi kullanılarak 23 vakanın 21’inde düzelme
elde edildi. 2 olguda trombektomi gerekli oldu. Takipte 2 hastada tekrarlayan
atak görüldü.
Sonuç: Penil Mondor hastalığı oldukça nadir olmakla
birlikte, hastalarda belirgin anksiyeteye sebep olur. Çalışmamızda etyolojide travmanın
etkinliğini ortaya koymuş olduk. Çoğunlukla konservatif tedavi ile kendiliğinden düzelir,
nadiren konservatif ile düzelmeyen hastalarda cerrahi tedavi gerekebilir.
Keywords
References
- 1-Laroche JP, Galanaud J, Labau D, et al. Mondor's disease: what's new since 1939?. Thromb Res 2012; 130: S56–S58
- 2-Katz R and Blachar A. Superficial dorsal penile vein thrombosis (Mondor's disease). Harefuah 1997 Apr 15;132(8):544-5, 607.
- 3-Al-Mwalad M, Loertzer H, Wicht A, et al. Subcutaneous penile vein thrombosis (Penile Mondor’s Disease): pathogenesis, diagnosis, and therapy. Urology. 2006; 67:586–588.
- 4-Özkan B, Coskuner ER, Turk A, Akkus E, Yalçın V. Penile Mondor disease and its effect on erectile function: results of 30 patients. Urology 2015 Jan;85(1):113-7.
- 5-Zidani H, Foughali M and Laroche JP. Superficial venous thrombosis of the penis: penile Mondor's disease? A case report and literature review. J Mal Vasc. 2010 Dec; 35 (6): 352-4
- 6-Pittaka M, Fotiou E, Dionysiou M, et al. Penile Mondor's disease in a patient treated with radical chemoradiation for anal cancer. Oxf Med Case Reports. 2017 Aug 2;2017(8):omx036. doi: 10.1093/omcr/omx036. eCollection 2017 Aug.
- 7-McLaren AJ, Riazuddin N and Northeast AD. Mondor meets Trendelenburg: penile vein thrombosis after varicose vein surgery. J R Soc Med 2001; 94:292–293.
- 8-Jung YH and Ryu DS. Mondor's Disease of the Penis Mistaken for Penile Fracture. Urogenit Tract Infect. 2016 Apr;11(1):39-41 doi.org/10.14777/uti.2016.11.1.39
- 9-Sasso F, Gulino G, Basar M, et al. Penile Mondors disease: an underestimated pathology. Br J Urol 1996; 77:729–732. 8.
- 10-Shapiro RS. Superficial dorsal penile vein thrombosis (penileMondor’s phlebitis): ultrasound diagnosis. J Clin Ultrasound 1996; 24:272–274.
- 11-Boscolo-Berto R, Iafrate M, Casarrubea G and Ficarra V.Magnetic resonance angiography findings of penileMondor’s disease. J Magn Reson Imaging 2009; 30:407–410.
- 12-Manimala NJ and Parker J. Evaluation and Treatment of Penile Thrombophlebitis (Mondor's Disease). Curr Urol Rep. 2015 Jun;16(6):39.
- 13-Dobran M Sr, Benigni R Jr, Nasi D Sr and Cantoro D. Penile Mondres’ disease after anterolateral retroperitoneal approach for lumbar fracture. BMJ Case Rep 2017 Nov 1; 2017.
- 14-Girolami A, Simioni P, Scarano L, et al. Venous and arterial thrombophilia. Haematologica 1997; 82: 96 A100.
- 15-Swierzewski SJ, Denil J and Ohl DA. The management of the penis with Mondor's phlebitis: Superficial dorsal penile and thrombosis. J Urol 1993; 150 (1): 77ews78.
- 16-Öztürk H. Penile Mondor's disease. Basic Clin Androl 2014 Mar 3;24:5. doi: 10.1186/2051-4190-24-5. eCollection 2014.
Retrospective Analysis of Penile in Superficial Dorsal Vein Thrombosis
Abstract
Introduction: Penile
superficial venous thrombosis is a rare and little-known benign genital
condition. The largest series of penile superficial venous thrombosis cases in
literature include 25 and 30 patients.
Material-Methods: A
retrospective evaluation was made of the data of 23 patients who were treated
and followed up for a diagnosis of PMD in the Urology Outpatient Clinic between
January 2009 and January 2018. Anamnesis, superficial vein color Doppler
ultrasonography and routine laboratory analysis (i.e. blood count, electrolytes
and coagulation tests) were applied to the patients. A conservative approach
was provided the use of NSAIDs, anti-coagulant agents and topical Arnica
Montana, and avoidance of the sexual activity. Follow-up examinations were made
after 1, 3, 5, and 8 weeks and 3 months of treatment. Clinical improvement was
evaluated.
Results: The age
of the patients in the study was mean 42.4 ±11.12 years and median 44 years
(range, 22-66 years). The mean BMI of the patients was 28.5±2.48 (range,
22.91-34.31). The mean period between the onset of symptoms and presentation
was 9.35±13.42 days, median 4 days, and range, 1-60 days. On presentation, all
the patients had painless palpable cord symptoms. In 20 patients, the
thrombotic vein could not be determined externally. The diameter of the
thrombosis was mean 3.09±1.04mm and median 3mm (range, 1.8–5). The diameter of
the obstructed veins ranged from 1.3 to 4.7 mm. No pathological findings were
determined in the standard laboratory tests of all 23 patients. The lesions
were found to be parallel to the sulcus below the coronal sulcus in 8 patients
(video), and 15 patients had a cord-like lesion on the dorsal penis (picture).
The venous color Doppler ultrasound results were similar for all the patients.
No color filling and flow spectrum was observed in the lumen of the superficial
vein on color Doppler US. In the etiology, prolonged sexual activity was
determined in 8 patients, prolonged masturbation in 5, the use of a vacuum
erection device in 3, and 7 patients were idiopathic. Only 1 patient had a
history of PMD development. Conservative treatment was applied to 21 of the 23
cases. Thrombectomy was required in 2 cases. At follow-up examination, two
recurrent episodes were observed.
Conclusions: Penile
Mondor’s disease is rare, but causes noticeable anxiety in patients. The
results of this
study demonstrate the effect of trauma in the
etiology. Patients generally recover with
conservative treatment, and occasionally
surgical treatment may be necessary.
Keywords
References
- 1-Laroche JP, Galanaud J, Labau D, et al. Mondor's disease: what's new since 1939?. Thromb Res 2012; 130: S56–S58
- 2-Katz R and Blachar A. Superficial dorsal penile vein thrombosis (Mondor's disease). Harefuah 1997 Apr 15;132(8):544-5, 607.
- 3-Al-Mwalad M, Loertzer H, Wicht A, et al. Subcutaneous penile vein thrombosis (Penile Mondor’s Disease): pathogenesis, diagnosis, and therapy. Urology. 2006; 67:586–588.
- 4-Özkan B, Coskuner ER, Turk A, Akkus E, Yalçın V. Penile Mondor disease and its effect on erectile function: results of 30 patients. Urology 2015 Jan;85(1):113-7.
- 5-Zidani H, Foughali M and Laroche JP. Superficial venous thrombosis of the penis: penile Mondor's disease? A case report and literature review. J Mal Vasc. 2010 Dec; 35 (6): 352-4
- 6-Pittaka M, Fotiou E, Dionysiou M, et al. Penile Mondor's disease in a patient treated with radical chemoradiation for anal cancer. Oxf Med Case Reports. 2017 Aug 2;2017(8):omx036. doi: 10.1093/omcr/omx036. eCollection 2017 Aug.
- 7-McLaren AJ, Riazuddin N and Northeast AD. Mondor meets Trendelenburg: penile vein thrombosis after varicose vein surgery. J R Soc Med 2001; 94:292–293.
- 8-Jung YH and Ryu DS. Mondor's Disease of the Penis Mistaken for Penile Fracture. Urogenit Tract Infect. 2016 Apr;11(1):39-41 doi.org/10.14777/uti.2016.11.1.39
- 9-Sasso F, Gulino G, Basar M, et al. Penile Mondors disease: an underestimated pathology. Br J Urol 1996; 77:729–732. 8.
- 10-Shapiro RS. Superficial dorsal penile vein thrombosis (penileMondor’s phlebitis): ultrasound diagnosis. J Clin Ultrasound 1996; 24:272–274.
- 11-Boscolo-Berto R, Iafrate M, Casarrubea G and Ficarra V.Magnetic resonance angiography findings of penileMondor’s disease. J Magn Reson Imaging 2009; 30:407–410.
- 12-Manimala NJ and Parker J. Evaluation and Treatment of Penile Thrombophlebitis (Mondor's Disease). Curr Urol Rep. 2015 Jun;16(6):39.
- 13-Dobran M Sr, Benigni R Jr, Nasi D Sr and Cantoro D. Penile Mondres’ disease after anterolateral retroperitoneal approach for lumbar fracture. BMJ Case Rep 2017 Nov 1; 2017.
- 14-Girolami A, Simioni P, Scarano L, et al. Venous and arterial thrombophilia. Haematologica 1997; 82: 96 A100.
- 15-Swierzewski SJ, Denil J and Ohl DA. The management of the penis with Mondor's phlebitis: Superficial dorsal penile and thrombosis. J Urol 1993; 150 (1): 77ews78.
- 16-Öztürk H. Penile Mondor's disease. Basic Clin Androl 2014 Mar 3;24:5. doi: 10.1186/2051-4190-24-5. eCollection 2014.
Details
| Primary Language | English |
|---|---|
| Subjects | Urology |
| Journal Section | Original Article |
| Authors | |
| Publication Date | June 12, 2020 |
| Published in Issue | Year 2020 Volume: 15 Issue: 2 |
