Doctors Lounge - Urology Answers
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Forum Name: Urology Topics
Question: penile Mondor's disease or urethritis?
|j.jones - Sun Jul 11, 2010 4:48 am||
Thank you for taking my questions. I will try to be as thorough as possible.
I am 30 years old and uncircumcised. At the end of April while masturbating I felt pain for a moment along the shaft of my penis. There was no loss of erection and I finished with no problems. Five days after the pain I noticed a lump in the shaft. This is like a two centimetre cord or worm underneath the skin. It begins roughly where I felt the pain, which corresponds to a vein on the right side of the shaft, roughly half-way between groin and glans. The lump begins from this vein, which now coils around it, and continues cross-wise almost until the dorsal vein on top of the penis. The area around the vein gave me faint pain/discomfort/burning; the lump was asymptomatic.
After a few more days I noticed that more urine than normal remained in my penis after urinating (instead of a couple of drops, five or six). I had no dysuria. I then went to A&E as I wasn’t registered with a family doctor at the time. The doctor couldn’t see anything. In fact the lump is sometimes not visible, it deflates or disappears if I lie down, take a shower, or if my penis becomes very small (as was the case at the A&E, given the doctor was a woman and I was embarrassed).
Three weeks after the initial pain (at the start of May) I visited an expert andrological surgeon privately. He examined me manually and felt the testes. Again the lump wasn’t visible. The urologist said it could be early Peyronie’s or Mondor’s. The problem with the latter is that the vein should be visible when flaccid. He suggested a Doppler scan, but as this would be very expensive privately, he told me to register with the NHS and get a referral to him. I have done so, but unfortunately my appointment is on August 12th. I then took one week Ibuprofen max dosage (3x400mg daily).
With this treatment I felt better, but after walking a lot for three consecutive days, I felt again distinctively sorer, and had more problems urinating. Approximately 5 weeks into the problem, I had a lot of problems urinating and my bladder was very uncomfortable. I felt a mixture of burning, and tension as if I needed to go even though I had just done so. This gradually subsided after a few days. I started Ibuprofen again, this time for two weeks, after which I had to stop because it gave me rebound headaches. The burning in the penis did not stop. (I also started applying Hirudoid, an heparinoid, with no success.)
In June I began having occasional pain where my right testicle attaches to the groin, a very similar sensation to the one in the penis: tight and burning. Around the same period, the end of the vein in question also started to burn. This is where the vein separates in two at the tip of my foreskin, going around both sides of it (above and below). The length of this vein between the original lump and the tip has become more coiled, while before it was a smooth arch. Also, another very faint swelling has appeared, similar to the first lump but less pronounced, I believe because there is more skin in the area. To my eyes, this new swelling is connected to the new area of pain. The dribbling urine has continued throughout (there is no ‘pressure’ at the end).
I had no sex since this problem began (and know for sure that it cannot be related to an STD). However, I did masturbate very occasionally (with pauses of ten days, two weeks, and even 24 days). I now regret this, as I understand it must have worsened my condition. (I am right-handed, so I grab with my palm the area of the foreskin where the new pain/swelling has occurred.)
I wouldn’t be writing to you if a couple of days ago I hadn’t had a bad case of hematuria. Urinating had become increasingly difficult, until frank red urine came out. I went to the A&E, where they diagnosed me with a bad urinary trait infection. The doctor (not a urologist) looked at my penis and said the vein was normal and the pain must be related to the infection. I am on antibiotics, which stopped immediately the hematuria, but the burning on the right tip of the foreskin is unchanged. I obviously don’t deny the UTI, but what of the rest? Could the UTI cause the burning vein? Or could Mondor’s disease have caused the infection?
Assuming I do have Mondor’s (and sclerosing lymphangitis), this seems not to be resolving itself, partly because of my stupidity. I still have to wait a month to see a urologist. Can the inflammation damage the vein? From what I have read, the processes involved in Mondor’s seem similar to those of varicose veins. I have noticed than in the mornings, after being horizontal through the night, I am often asymptomatic. Everything in the penis (lump, swelling, vein) is less visible or invisible if I lie down, or simply lift the penis so that gravity helps circulation. Could blood be pooling at the tip of the foreskin and the vein becoming varicose (hence the coiling)? (I’ve stopped wearing underwear because of the burning, so the penis is always vertical, like a leg.) Or is the penis too short a structure for this process to kick in? Very close to where the vein in question goes into my groin, so above the original lump, there are numerous spider veins. I have had these for a long time, but I am sure they have been reaching down the shaft (one in particular almost reaches the tip of the foreskin). If valves in the vein were damaged, wouldn’t my capacity to maintain an erection also be damaged?
I understand you will not be able to diagnose me through an email, but maybe you could speculate on the issue? (And tell me if I need to see a urologist immediately…)
|Dr.M.Aroon kamath - Fri Jul 23, 2010 12:17 am||
A very unusual clinical presentation indeed! If it were Mondor disease, it should not disappear on lying down or periodically. As it has happened, Mondors can be confidently excluded. Also, in Mondor's, the thrombosed and inflammed vein(veins) will remain palpable (to an expert clinician) even when the penis is flaccid(although to a lesser extent).
A more plausible explanation for this scenario is one wherein vigorous manipulation of the penis during masturbation perhaps resulted in
- the rupture of one of the superficial veins, resulting in a lax hematoma and
- perhaps a minor urethral trauma.
Very violent manipulations of the penis are capable of causing fractures of the penis as well( very rarely causing corporal herniation).
In conclusion, i can only comment that the symptomatology (as provided) in your case is highly unusual and difficult to assign confidently to a particular diagnosis.You must consult a urologist soon and have it sorted out.
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