When erections fade too fast, the problem may be in the veins
Venous leak — also called veno-occlusive dysfunction — is one of the most common vascular causes of erectile dysfunction, and it often explains why pills like sildenafil or tadalafil stop working. It can be diagnosed precisely and treated with a minimally invasive procedure.
Call to book: 737-241-2184 How treatment worksWhat is venous leak?
A normal erection depends on two things happening at once: arteries must fill the penis with blood, and the veins must close off so that blood stays trapped inside. Doctors call the second part the veno-occlusive mechanism. If either step fails, the erection suffers.1
With venous leak, blood flows in normally, but it drains out again through veins that don't seal properly. The result is an erection that is hard to reach or keep — even when the arteries are healthy.
Venous leak is no rarity. Recent research suggests it is the most common vascular cause of ED, and it accounts for roughly half of vascular cases that don't respond to medication.4,3 Patients with venous ED also tend to be younger than those whose ED stems from blocked arteries.1
What causes venous leak?
The veins of the penis are compressed by the expanding erectile tissue during an erection. When that tissue becomes stiffer or the veins themselves are abnormal, the seal is incomplete. Contributing factors include:
- Age-related changes in erectile tissue. Researchers have proposed that reduced blood supply over years can lead to scarring (fibrosis) of the erectile tissue, which in turn weakens the venous seal.1
- Prior pelvic or urological procedures, injury, or radiation.2,3
- Vascular risk factors such as smoking, diabetes, high blood pressure and high cholesterol, which affect both arteries and erectile tissue.
- Anatomical variations — extra or enlarged draining veins that some men have from early on.
Venous leak can also occur together with narrowed arteries (“mixed” vascular ED). That is why a careful work-up of both inflow and outflow matters before treatment.5
How we find out whether you have a venous leak
Choosing the right treatment depends on an accurate diagnosis, so we follow a step-by-step work-up based on the published diagnostic algorithm.1,4
Consultation & questionnaire
A detailed history, review of medications and risk factors, and the IIEF questionnaire — a standard score used to measure erectile function before and after treatment.
Penile duplex ultrasound
After a small injection that triggers an erection, ultrasound measures blood flow. Persistently high flow at the end of the heartbeat cycle (end-diastolic velocity above about 5 cm/s) points to a venous leak.4
Treatment options for venous leak
Treatment usually starts with lifestyle changes and medication. When tablets don't give a usable erection — which is the case for up to half of men taking them3 — closing off the leaking veins addresses the cause directly.
| Option | How it works | Things to know |
|---|---|---|
| Risk-factor control | Stopping smoking, managing blood sugar, blood pressure and cholesterol, exercise | Important for every patient; supports any other treatment |
| ED tablets (PDE5 inhibitors) | Increase blood flow into the penis | Often not enough when blood leaks out too quickly |
| Surgical vein ligation | Leaking veins are tied off in an open operation | Usually done under general anesthesia; long-term success reported at around 25%2,3 |
| Venous leak embolization | Leaking veins are sealed from the inside through a tiny needle access | Minimally invasive, local anesthesia with light sedation, no incision2,6 |
| Penile implant | Surgically placed device | Reliable, but irreversible; typically considered when other options have failed |
What happens during venous leak embolization
The technique we use — access through a vein on the top of the penis (the deep dorsal vein) under ultrasound guidance — was developed and published by Dr. Hanno Hoppe and Dr. Nicolas Diehm in Switzerland.2,6
Preparation
Local anesthetic is applied and you receive light sedation. You stay awake but comfortable; no general anesthesia is needed.
Ultrasound-guided access
Using ultrasound, a very fine needle is placed into the deep dorsal vein. A thin wire and small catheter follow — no surgical incision is made.
Mapping the leak
An erection is induced with medication and contrast dye is injected. X-ray imaging shows exactly which veins are leaking.3
Recovery
The needle is removed and a small dressing applied. Patients go home the same day with clear instructions for the following weeks.
Results
The published results below come from the Swiss registry of patients whose ED had not responded to tablets — men with severe ED, not a hand-picked group.
Technical success — the target veins were completely sealed in 49 of 50 patients in the first study and in 193 of 194 procedures in the larger follow-up registry.3,7
Meaningful improvement in erectile function: 68% at 6 weeks in the first 50 patients, and about 59% at an average of 9 months in a group of 175 patients.3,7
Rate at which a leak returned or persisted over an average of about 16 months — usually because of new collateral veins, which can often be treated again.7
Results in our practice
Of the patients we have treated with venous leak embolization since 2024, 80% reported a clinically meaningful improvement in erectile function — measured, as in the published studies, as a gain of at least 4 points on the IIEF questionnaire, assessed 3 months after treatment. These are our own internal figures, not a published study.
For men with both narrowed arteries and venous leak who had not improved enough after arterial treatment, adding embolization raised the share with meaningful improvement from about 12% to 65%.5 “Meaningful improvement” in these studies means a gain of at least 4 points on the IIEF score. Individual results vary, and no treatment can guarantee success.
Risks and side effects
In the first 50-patient study, no major complications occurred during follow-up.3 As with any procedure, there are risks, which we discuss with you in detail beforehand:
- Temporary bruising, swelling or tenderness of the penis
- Inflammation of a penile vein (phlebitis), which is usually treated with anti-inflammatory medication
- Rarely, glue travelling beyond the target veins. In the 175-patient registry, small glue particles reached the lungs in 3 patients (1.7%).7
- Reaction to contrast dye or sedation
- Recurrence of the leak over time
Frequently asked questions
Is the procedure painful?
It is performed under local anesthesia with light sedation. Most patients describe pressure and mild discomfort rather than pain. Some soreness for a few days afterward is normal.
How long does it take, and do I need to stay overnight?
The procedure typically takes 30 to 60 minutes, and you go home the same day — no overnight stay is needed.
When can I resume sexual activity?
Your physician will give you a specific timeline, usually after a short healing period of a few weeks. Erectile function is reassessed at follow-up visits.
Can I still use ED tablets after treatment?
Yes. Many men find that tablets work better once the leak is sealed, because blood is no longer escaping as quickly.
What if the leak comes back?
A recurrence is uncommon but possible, usually because new collateral veins form. A follow-up scan can show this, and repeat treatment is often possible.7
Is it covered by insurance?
Coverage varies by policy. We will navigate out-of-pocket costs with you. Call us at 737-241-2184 with questions.
Find out whether venous leak is behind your ED
If ED tablets haven't worked for you, a vascular assessment can show whether a venous leak is the cause — and whether embolization could help.
Call 737-241-2184 to scheduleReferences
- Hoppe H, Diehm N. Percutaneous treatment of venous erectile dysfunction. Front Cardiovasc Med. 2021;7:626943. doi:10.3389/fcvm.2020.626943
- Hoppe H, Diehm N. Venogenic erectile dysfunction: diagnosis on computed tomography cavernosography and endovascular treatment using an anterograde access via deep dorsal penile vein. CVIR Endovasc. 2022;5:10. doi:10.1186/s42155-022-00283-5
- Diehm N, Pelz S, Kalka C, et al., Hoppe H. Venous leak embolization in patients with venogenic erectile dysfunction via deep dorsal penile vein access: safety and early efficacy. Cardiovasc Intervent Radiol. 2023;46:610–. doi:10.1007/s00270-023-03412-2
- Hoppe H, Hirschle D, Schumacher MC, et al., Diehm N. Erectile dysfunction: role of computed tomography cavernosography in the diagnosis and treatment planning of venous leak. CVIR Endovasc. 2023;6:56. doi:10.1186/s42155-023-00403-9
- Diehm N, Hirschle D, Kalka C, et al., Hoppe H. Venous leak embolization results in clinical improvement of patients with mixed arterio-venous erectile dysfunction not responding to arterial revascularization alone. Cardiovasc Intervent Radiol. 2024 (epub Dec 5).
- Hoppe H, Diehm N. To the editor — an update on endovascular treatment of venogenic erectile dysfunction. CVIR Endovasc. 2022;5:30. doi:10.1186/s42155-022-00310-5
- Heymann G, Gutwein A, Glenck M, et al. Midterm outcomes of venous leak embolization in patients with venogenic erectile dysfunction unresponsive to phosphodiesterase-5 inhibitors. Cardiovasc Intervent Radiol. 2026. PMID 41162635.
This page provides general information and does not replace a personal medical consultation. Study results describe groups of patients and cannot predict the outcome for an individual. Urology Austin and IR Centers · 8701 N. Mopac, Suite 100, Austin, Texas 78759 · 737-241-2184