Superficial dorsal penile vein thrombosis: a little‐known complication of subinguinal varicocelectomy

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The superficial dorsal penile vein thrombosis (SDPVT) has been described in connection with different medical and surgical conditions but never in subinguinal varicocelectomy. This study provides the description of a new surgical complication in the subinguinal varicocelectomy: SDPVT. We analysed the pathophisiology and the management of this entity. OBJECTIVE To describe the symptomatology, diagnosis and treatment of superficial thrombosis of the dorsal penile vein – the most common complication of subinguinal varicocelectomy – and analyse the possible mechanisms involved in the development of the condition. PATIENTS AND METHODS The clinical records of 326 patients who underwent varicocele repair during the last 10 years was reviewed. The technique used was subinguinal varicocelectomy with arterial preservation. A mini‐Doppler probe was used during surgery for artery identification. We report on the postoperative complications of varicocelectomy, with special attention to superficial dorsal penile vein thrombosis, and provide a detailed description of the anatomy of the superficial venous system of the penis. RESULTS Complications usually associated with varicocele surgery occurred in less than 1% of patients. However, the most common complication in our series was superficial dorsal penile vein thrombosis, which occurred in 2.1% of patients. The use of the mini‐Doppler probe allowed us to identify and preserve the arteries in all 326 patients. CONCLUSION Subinguinal varicocelectomy with intra‐operative use of a mini‐Doppler probe is a rapid and safe technique. The outcomes and complications are similar to those reported for subinguinal microscopic varicocelectomy. Superficial dorsal penile vein thrombosis is a benign self‐limited condition whose association with subinguinal varicocelectomy has not been previously reported.

Penile Mondor Disease and its Effect on Erectile Function: Results of 30 Patients

“…1,7 There are also case reports of penile Mondor's disease after inguinal hernia repair and subinguinal varicocelectomy. 8,9 Penile Mondor's disease is considered idiopathic if none of these etiologic factors are present in a patient. Deficiencies of antithrombin 3, protein-C, and protein-S are thought to be involved in these idiopathic cases.…”

“…In cases where conservative treatment is not effective or if there are recurrent episodes, surgical removal of the thrombus or excision of the superficial dorsal vein may be recommended. 9 Although the disease has a self-limiting course and the treatment is palliative, pharmacotherapy is widely considered useful to alleviate the symptoms and to reduce the duration of treatment during the acute stage of the disease. We have also prescribed pharmacotherapy in our series of 30 patients and used cefuroxime axetil, a secondgeneration cephalosporin, 500 mg twice daily for a week, acetylsalicylic acid 300 mg daily, and topical heparinoid ointment twice daily for a month.…”

Venous Thrombosis in Rare or Unusual Sites: A Diagnostic Challenge

“…Thrombosis in the superficial or deep vein of the penis is caused by trauma, excessive sexual activity, infections, pelvic trauma, and surgical procedures (subinguinal varicocelectomy, hernia repairs, etc.). [64][65][66][67] If only the superficial vein is involved, the condition is also known as Mondor disease of penis. 65,67 The clinical picture is characterized by local swelling, variable priapism, pain, and tenderness on palpation.…”

Superficial Penile Vein Thrombophlebitis After Microsurgical Varicocelectomy: Case Series

“…While a single series published in 2011 reported superficial penile vein thrombophlebitis after subinguinal varicocelectomy [ 11 ], this condition has not been well recognized as a possible complication of this surgery.…”