Venous leak, also called veno-occlusive dysfunction, is a cause of erectile dysfunction that medication often cannot fix. A normal erection depends on two things: blood flowing into the penis, and the veins that drain it being squeezed shut so the blood stays trapped. In venous leak, those veins keep draining. Blood flows in normally, but it escapes too fast, so an erection is weak, does not last, or fades when you change position.
Venous leak embolization closes the leaking veins from the inside through a catheter, as an outpatient procedure, without open surgery. At NYMD Center our urologists, led by Dr. David Shusterman, make the diagnosis and manage the full erectile dysfunction pathway, and Dr. Yosef Golowa, MD, FSIR, our interventional radiologist, performs the embolization.
Why men come to NYMD Center for venous leak
- Urology and interventional radiology in one group. Erectile dysfunction has many causes. Our urologists confirm that a venous leak is really the problem before any procedure is considered, and they handle every other option if it is not.
- The full range of ED treatment under one roof. Medication, injection therapy, vacuum devices, embolization and penile implants are all available, so the recommendation is not tied to one procedure.
- Outpatient, no open surgery. Embolization is done through a small needle puncture, and most men return to normal activity within a few days.
- Confidential and inclusive. We accept all insurance, including Medicare and Medicaid, and our urology team speaks English, Russian, Spanish, Italian, French and Vietnamese.
Signs that point to a venous leak
- you can get an erection but cannot keep it long enough;
- the erection fades quickly, often when you change position;
- medications such as sildenafil (Viagra) or tadalafil (Cialis) help little or not at all;
- erections were once reliable and became unreliable without an obvious cause.
How we make the diagnosis
The evaluation starts with a urologist: your history, an examination, and blood work such as testosterone, because low testosterone, diabetes, medications and blood vessel disease can all cause similar symptoms. A penile Doppler ultrasound then measures how fast blood flows into the penis and whether the veins are failing to close. When embolization is being planned, contrast imaging of the penis (cavernosography) shows exactly where the leak is.
Embolization is not the right treatment when erectile dysfunction comes mainly from poor blood flow into the penis, from nerve damage, or from psychological factors. In those cases we recommend a different treatment.
Treatment options compared
| Medication (PDE5 inhibitors) | Injection therapy | Venous leak embolization | Penile implant | |
|---|---|---|---|---|
| How it works | Increases blood flow into the penis | Medication injected into the penis before sex | Closes the leaking veins from the inside | A device placed in the penis creates an erection on demand |
| Fixes the leak? | No | No | Yes | No, it bypasses the problem |
| Anesthesia | None | None | Light sedation and local anesthetic | Anesthesia in an operating room |
| Recovery | None | None | Normal activity within a few days | Several weeks |
| Best for | Mild leaks or mainly arterial ED | Men who accept injecting before sex | A confirmed leak in a man with good arterial inflow | Severe ED when other options have failed |
Your procedure day, step by step
- Check-in. You arrive for an outpatient procedure; there is no hospital admission.
- Sedation. You receive light sedation, and the access area is numbed.
- Imaging. Contrast is placed into the erectile tissue so the leaking veins show up on live X-ray.
- Embolization. Through a small needle puncture, Dr. Golowa guides a thin catheter into the leaking veins and closes them with tiny coils, a sclerosing foam or medical glue.
- Home the same day. The catheter is removed, and you go home with a companion.
Recovery and results
- First days: mild bruising or soreness is common. Most men return to normal activity within a few days.
- Sexual activity: your doctor will tell you when to resume, usually after a short healing period.
- Results: many men notice firmer, longer-lasting erections, and some find that medication starts working again. Results vary, and some men need additional treatment over time; we follow you and adjust the plan.
What the evidence says
Venous leak embolization is an established technique, but published studies are smaller than for treatments such as PAE, and success rates vary between centers and over time. That is why careful selection matters: the best results come in men whose Doppler and imaging confirm a true venous leak and whose arterial blood flow is good. We discuss realistic expectations before you decide.
Risks to know about
Possible side effects include bruising or swelling at the puncture site, temporary penile discomfort, reactions to contrast, and recurrence of the leak through other veins. Serious complications are uncommon. We review your individual risks before treatment.
Questions patients ask
Why don't Viagra or Cialis work for venous leak?
Those medications increase blood flow into the penis, but they cannot stop blood from leaking out through veins that fail to close. That is why they often disappoint when the leak is significant.
How is a venous leak diagnosed?
With a urology evaluation, blood work and a penile Doppler ultrasound that measures blood flow in and out of the penis. Contrast imaging confirms where the leak is when a procedure is planned.
Is the procedure painful?
You are sedated and the access is a small needle puncture. Mild soreness or bruising for a few days is common afterward.
Will I still need ED medication afterward?
Some men do not; others find that medication works better than before. Results vary, and your urologist follows your progress and adjusts treatment.
Is venous leak embolization covered by insurance?
We accept all insurance, including Medicare and Medicaid. Coverage for the procedure depends on your plan and may need prior authorization, which we verify before scheduling.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, all insurance accepted, including Medicaid and Medicare.