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

• penis,Mondor hastalığı,tromboflebit

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

• Mondor's disease,penis,thrombophlebitis

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