We have been unable to find previous reports of thrombophlebitis of the superficial dorsal vein of the penis as a complication of long saphenous vein surgery. The incidence in this series, 3 per 231 patients, exceeds the 1% level of risk above which patients are usually warned as part of the consent process.
Anatomical studies of penile venous outflow have been performed by selective venography4,5
. The superficial dorsal vein drains the prepuce and skin of the penis into the right and left external pudendal veins and thence into the long saphenous vein at the groin. Superficial ventral veins also drain into the superficial dorsal vein. There is almost complete separation of the superficial and deep venous systems in the penis with the exception of occasional direct communications between the deep and superficial dorsal veins. It is therefore anatomically possible that a surgeon performing bilateral ligation of the tributaries of the saphenofemoral junction will interrupt the superficial venous drainage of the penis with consequent venous stasis and thrombophlebitis. In 20% of cases the superficial dorsal vein drainage is unilateral, presumably increasing the risk of venous occlusion after surgery.
Superficial thrombophlebitis of the penis presents with cord-like induration of the vein, associated with mild discomfort and inflammation. Most cases are reported to resolve completely, as did ours, with no permanent adverse effects on sexual function. Treatment with anti-inflammatory drugs is said to relieve symptoms but not to hasten resolution.
It is possible that this condition is underreported since it is self-limiting and most patients who undergo long saphenous surgery are not followed up.