Venous Leak: Difficult to Treat Cause of Erection Problems in Men  

by Alex Shteynshlyuger MD

When it comes to the treatment of erectile dysfunction – New York Urology Specialists are a step ahead.  Better Science Means Better Care.   


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Venous Leak Causes Problems with Obtaining and Maintaining Erections in Men

ED Caused by Venous Leak (Veno-Occlusive Insufficiency) in Men

What is Venous Leak or Veno-Occlusive Insufficiency?

Erections are caused by increased blood inflow to the penis.  The decreased outflow of blood from the penis allows an erection to be maintained. The maintenance mechanism that prevents blood from leaving the penis is the ‘corporo-occlusive” mechanism within the penis that involves collagen fibers, smooth muscle, and other support structures.

Venous leak refers to the failure of the corpora-occlusive mechanism within the penis to keep blood from leaving the penile shaft. 

Corporo-venous occlusive erectile dysfunction or veno-occlusive dysfunction can be caused by degenerative changes of tunica, changes to collagen components as a result of aging, Peyronie’s disease, diabetes or penile fracture.  

Decreased smooth muscle content may also contribute to venous leakage. Decreased amount of elastic fibers and increased collagen deposition are thought to be major contributors to ‘venous leak”.   Decreased smooth muscle can contribute to ED.  Trauma may also induce abnormal venous shunts that impair occlusive venous mechanisms in the penis.  This is also called ‘cavernosal’ ED because the problem originates in the mechanisms responsible for the maintenance of erection within the corpora cavernosa of the penis.

What are the Signs of Venous Leak Erectile Dysfunction?

A venous leak, or veno-occlusive insufficiency as it is more formally known, can occur as mild, moderate or severe problem contributing to erectile dysfunction in men.  When a venous leak is minor, it is often asymptomatic, as long as blood inflow is good, it can compensate for veno-occlusive insufficiency.

Most common symptoms of erectile dysfunction caused by a venous leak are erections that cannot be maintained, engorgement but no erection after taking medications such as Viagra or Cialis.  It is important to understand that men without venous leak but with arterial insufficiency can also experience similar symptoms.

How is Venous Leak Diagnosed?

A venous leak is suspected as a cause of erectile dysfunction in men who able to obtain erections but lose it very fast.  Veno-occlusive insufficiency is also suspected when medications such as Viagra or Cialis does not work well.

A definitive diagnosis of corporo-venous occlusive erectile dysfunction is made using penile Doppler ultrasound with an intra-cavernosal injection of prostaglandin or Trimix.  End-diastolic velocity, a parameter measured by duplex ultrasound, is typically greater than 5 mL/s in patients with a venous leak.  Normally, EDV (End-diastolic velocity) is less than 5

It is important to understand that severe anxiety can produce false results. Similarly, an inadequate dose of Trimix or prostaglandin can suggest veno-occlusive insufficiency when the problem may be related to arterial insufficiency or combined problem. Redosing with a higher dose of Trimix or SuperTrimix is usually advisable when the diagnosis is uncertain.

What are the Treatment Options for Fixing Venous Leak?

Veno-occlusive dysfunction is one of the most challenging problems to treat.  For some patients with a mild venous leak, medications such as Viagra or Cialis might work.  Using penile constrictive ring might allow men to maintain erections for a prolonged period of time.  Some men are successful in using vacuum erection devices or penile injections in combination with a penile constrictive ring.

For most men with moderate to severe erectile dysfunction caused by veno-occlusive insufficiency or combined erectile dysfunction caused by arterial and veno-occlusive insufficiency, penile implant offers the most effective treatment option

Inflatable penile prosthesis such as AMS-700 and Coloplast Titan OTR penile implant enable men with a severe venous leak to resume sexual activity.  The penile implant offers excellent effectiveness for treatment of moderate-severe venous leak and mixed vascular erectile dysfunction even when medications such as Viagra and Cialis do not work

Ineffective Treatment Options for Men with Venous Leak or Mixed Vascular Insufficiency

It is important for men to understand that certain treatments will not be beneficial if a venous leak or veno-occlusive insufficiency is the underlying cause of ED. Similarly, if there is a combined vascular insufficiency with poor blood delivery (arterial insufficiency) and failure of blood to remain in the penis (venous leak), the severity of erectile dysfunction tends to be more severe.  Many men come to us after trying multiple treatments for ED without success. Many men resort to expensive and ineffective treatments such as plasma and platelet injections for ED.

The following treatments are ineffective in men with a moderate-to-severe venous leak or mixed vascular insufficiency:

Medications such as Viagra and Cialis that are offered online by outlets such as GetRoman and others are typically ineffective for men with veno-occlusive erectile dysfunction. Trimix injections offered by Boston Medical, as well as at New York Urology Specialists, often result in semi-erection of 40-60% hardness but not adequate for intercourse.

Shockwave therapy for ED typically does not lead to a significant benefit in men with a moderate-to-severe venous leak.  Similarly, the platelet injections are of no benefit to men with veno-occlusive vascular insufficiency or venous leak as the underlying cause of erectile dysfunction.

Can Surgery Fix Venous Leak?

Surgical treatment has been tried to correct veno-occlusive insufficiency.  Currently, the surgeries are not recommended because long-term success beyond 1-2 years is poor and most men require additional treatment.

Scheduling Appointments for Venous Leak Treatment of ED in Men at New York Urology Specialists


If you have any questions, to schedule a consultation please contact us or call/text: 1-646-663-5211.

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ED is Treatable in Nearly Every Man

Excellence-Urology_Care-banner2At New York Urology Specialists, our urologists are specially trained in the evaluation and treatment of erectile dysfunction.  We understand the challenges that ED creates for our patients, their relationships and their self-esteem.  We help you find a treatment for erectile dysfunction that fits your needs, your lifestyle and your preferences.

Urologists are doctors specializing in the treatment of men with erectile dysfunction. By the virtue of our experience and skill, we are able to offer an effective treatment option for nearly every man who desires an effective treatment for ED.  We offer medical and surgical treatment for erectile dysfunction.

We Treat Some of the Most Complex ED Problems Including:

ED Caused by Venous Leak (Veno-Occlusive Insufficiency) in MenSchedule an Appointment with Dr. Shteynshlyuger:

Call/text today: 1-646-663-5211 or make an appointment online

Dr. Alex Shteynshlyuger is a fellowship-trained board-certified urologist with expertise in evaluation and treatment of sexual and erection problems in men using modern effective and proven treatment methods.  We offer inflatable penile implant, shockwave therapy for ED and treatment for Peyronie’s disease.

He is highly recommended by top primary care physicians in the New York area. If you or someone you know has been experiencing urological symptoms, make an appointment to take advantage of Dr. Shteynshlyuger’s expert advice. Please feel free to contact us with any questions.


If you have any questions, to schedule a consultation please contact us or call/text: 1-646-663-5211.