Subcutaneous penile vein thrombosis (Penile Mondor's Disease): pathogenesis, diagnosis, and therapy.

OBJECTIVES: In international studies, only a few data are available on subcutaneous penile vein thrombosis. The pathogenesis is unknown, and no general recommendation exists regarding therapy. METHODS: A total of 25 patients with the clinical picture of a "superficial penile vein thrombosis" were treated at our policlinic. All patients had noted sudden and almost painless indurations on the penile dorsal surface. The extent of the thrombosis varied. Detailed anamnesis, ultrasonography, and routine laboratory tests were performed for all patients, knowing that primary therapy was conservative. RESULTS: No patient indicated any pain. Some reported a feeling of tension in the area of the thrombosis. In all patients, the thrombosis occurred in the dorsal penis shaft. It was close to the sulcus coronarius in 21 patients, near the penis root in 3, and in the entire penis shaft in 1 patient. The length of the thrombotic vein was between 2 and 4 cm. The ultrasound results were similar for all patients. The primary treatment was conservative for all patients. Recovery was achieved in more than 92% of cases (23 of 25 patients) using conservative therapy, which consisted of local dressing with heparin ointment (10,000 IU) and oral application of an antiphlogistic for 14 days. In 2 cases, thrombectomy was necessary. CONCLUSIONS: Extended imaging diagnosis does not improve the evaluation of the extent of a superficial penile vein thrombosis. Conservative primary therapy consisting of heparin ointment and oral application of antiphlogistics is sufficient. If the thrombosis persists after conservative therapy, surgery is indicated.

[Gemcitabine/cisplatin vs. MVAC. 5 year survival outcome of the phase III study of chemotherapy of advanced urothelial carcinoma in Germany]. / Gemcitabin/Cisplatin vs. MVAC. 5-Jahres-Ergebnisse der Phase-III-Studie zur Chemotherapie des fortgeschrittenen Urothelkarzinoms in Deutschland.

Of 405 patients with stage IV transitional cell carcinoma from an international multicenter phase III trial, 70 were randomized in Germany to receive either gemcitabine/cisplatin or standard MVAC systemic chemotherapy for locally advanced or metastatic urothelial cancer. Overall survival as the primary endpoint of the study was similar in both arms (median survival GC 15.4 months vs MVAC 16.1 months), as were tumor-specific survival and time to progressive disease. In the intent-to-treat analysis, the 5-year overall survival rate was 10% for patients randomized to GC and 18% randomized to MVAC. Tumor overall response rates (GC 54%, MVAC 53%) were similar. The toxic death rate was 0% in the GC arm and 3% (one patient) in the MVAC arm. Significantly more GC than MVAC patients experienced grade 3/4 anemia (GC 52%, MVAC 20%) with significantly more red blood cell transfusions in the GC arm.Significantly more GC than MVAC patients had grade 3/4 thrombocytopenia (GC 54%, MVAC 17%) without grade 3/4 hemorrhage or hematuria in either arm. More MVAC patients experienced grade 3/4 neutropenia (GC 56%, MVAC 61%, p=1.000), neutropenic or leukopenic fever (GC 0%, MVAC 10%, p=0.237), mucositis (GC 0%, MVAC 7%, p=0.495), and alopecia (GC 6%, MVAC 36%, p=0.004). GC represents a reasonable alternative for the palliative treatment of patients with locally advanced and metastatic transitional cell carcinoma. Sustained long-term survival was only found for patients with locally advanced cancer, lymphatic metastases, or solitary distant metastasis but not for visceral metastatic disease.