DORSAL VEIN-THROMBOSIS OF THE PENIS PRESENTING TO AN STD CLINIC

Objective-To describe the clinical assessment, diagnosis and different ial diagnosis of dorsal vein thrombosis of the penis (DVTP) and to obs erve its natural course over time. Design-A descriptive study of six p atients presenting with penile swelling to an STD clinic over a twenty month period. Subjects-Six male patients between the ages of 22 and 4 6 years who self-presented to an STD clinic in Perth, Western Australi a during a period from October 1991 to June 1993. Methods-Initial hist ory, examination and follow up were undertaken as routine for all STD clinic patients. This was supplemented with later exhaustive history t aking; full cardiovascular, fundoscopic, abdominal and genital examina tion; blood screening for coagulation defects, glucose level, autoanti bodies, ESR, urea, electrolytes, calcium, creatinine and liver functio n test; and duplex doppler ultrasound scanning. Results-No consistent abnormalities were detected on clinical examination, nor on blood test ing. Ultrasound revealed one case of rupture of the corpus cavernosum. with haematoma and thrombus formation. There were two cases of pure D VTP demonstrable with ultrasound and two cases in which spontaneous re solution of clinical DVTP has occurred. The sixth patient declined fur ther investigation and followup, but also displayed the clinical featu res of DVTP. Coagulation abnormalities as seen in elevated antithrombi n III levels are of unknown significance. Conclusions-DVTP and rupture d corpus cavernosum should be considered in the differential diagnosis of gradual onset penile swelling and/or deformity. Its natural course tends to be one of spontaneous resolution. No sexual or urinary sympt oms or dysfunction were experienced, even in the presence of persisten t thrombus. Directed and specific investigation only, depending on the clinical state of the patient, should be carried out.