JCU - January 2022 - 66

914830
URO
Journal of Clinical UrologySharma and Ajjikuttira
Case Review
" Groin pain, hard vein " : A rare
case of penile Mondor's disease
in a patient with factor V Leiden
mutation
Pranav Sharma1,2 and Aiyapa Aruna Ajjikuttira1
Journal of Clinical Urology
2022, Vol. 15(1) 66 -69
© British Association of
Urological Surgeons 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/2051415820914830
journals.sagepub.com/home/uro
https://doi.org/10.1177/2051415820914830
Keywords
Mondor's disease, factor V Leiden, thrombosis, thrombophilia, dorsal penile vein
Date received 4 November 2019; accepted 19 February 2020
Introduction
Dorsal penile vein thrombosis, or penile Mondor's disease
(PMD), is a rare thrombophlebitis of the subcutaneous
penile vessels. It is commonly observed in patients with a
history of excessive sexual activity, penile trauma, pelvic
surgery, sexually transmitted infections, intracavernous
drug use, or malignancy.1 The underlying pathophysiology
is unknown but is linked to Virchow's triad of endothelial
injury, venous stasis and hypercoagulability.1 There is,
however, little evidence in literature of this condition
resulting from a primary hypercoagulable state. We report
on a patient with spontaneous PMD who was homozygous
for the factor V Leiden mutation.
Case report
We present a case of a previously asymptomatic 33-yearold
Bosnian gentleman who presented to our emergency
department with a 5-day history of spontaneous cordlike
hardening of his superficial dorsal penile vein with
localized pubic and penile tenderness. He described the
pain as a constant dull ache originating from the groin
and along the penile shaft, exacerbated by erections, on
physical movement, and on palpation. There was no
recent history of vigorous sexual activity or masturbation.
Our patient had no penile trauma or difficulty with
erections. No urethral discharge, haematuria, dysuria,
urgency, or fever was described. He reported no testicular
pain or swelling. A recent sexually transmitted
infection check with his family physician had cleared
him for gonorrhoea and chlamydia. He had abstained
from sexual intercourse for the last 1 month following
a breakup from a long-term heterosexual relationship.
There was no pain or discomfort during the abstinence
period and no previous history of similar episodes. The
patient was an otherwise healthy male, a non-smoker,
and a known homozygous carrier of the factor V Leiden
mutation. He had, however, never developed any thromboembolic
compilations to date nor received any form
of anticoagulation for the latter.
On examination he was a circumcised male with a tender,
firm, non-compressible 5 cm cord-like thickening of
the superficial dorsal penile vein starting at the base of the
penis and extending distally along the entire length of the
penis (Figure 1). There was localized tenderness along
the vein and over the pubic region but no overlying erythema
or oedema. No abnormal curvature of the penis was
noted. There was no priapism or inguinal hernias. Per rectal
examination revealed a smooth, non-enlarged benignfeeling
prostate. Rest of the genitourinary examination
was normal. His vital signs were within normal limits.
1Princess Alexandra Hospital, Australia
2Faculty of Medicine, University of Queensland, Australia
Corresponding author:
Dr Pranav Sharma, Resident Medical Officer, Princess Alexandra
Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
Email: pranavs041@gmail.com
https://uk.sagepub.com/en-gb/journals-permissions https://www.doi.org/10.1177/2051415820914830 https://journals.sagepub.com/home/uro

JCU - January 2022

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