Venous Leak Diagnosis And Treatment

Vein, Heart, and Vascular Institute

Cardiovascular Doctors & Interventional Cardiologists located in Tampa, FL & Wesley Chapel, FL

If you have trouble getting or maintaining an erection, the problem may involve blood flowing into the penis, blood draining out too quickly, or both. At Vein, Heart and Vascular Institute (VHVI), we evaluate both the arterial and venous sides of erectile dysfunction (ED) to help determine what is contributing to your symptoms.

A venous leak, also called veno-occlusive dysfunction or venogenic erectile dysfunction, means the erectile tissue is not retaining blood as it normally would during an erection. Difficulty maintaining an erection can be a clue, but it does not establish the diagnosis on its own.

Venous Leak Diagnosis and Treatment Q & A

How do we evaluate vascular ED?

We begin with your symptoms, medical history, medications, prior ED treatments, and relevant health conditions. When appropriate, a penile Doppler ultrasound helps assess arterial inflow and look for findings that may suggest a venous leak.

The quality of the erection during testing matters when interpreting the results. If more detail about venous drainage would affect a treatment decision, we may discuss a cavernogram, also called cavernography. This test uses contrast imaging to show the venous drainage pathways. It is considered selectively; not every patient with ED needs one.

Why assess arteries as well as veins?

An erection requires adequate arterial blood flow as well as the ability to retain that blood. A patient may have an arterial problem, a venous problem, or a combination of the two. Identifying which factors are present helps us discuss the appropriate options. When testing suggests an arterial problem, we assess whether additional evaluation or an arterial treatment may be appropriate.

What treatments are available?

Treatment depends on the cause of your ED and your goals. For selected patients whose evaluation supports treatment of abnormal venous drainage, Dr. Hesham Fakhri may discuss venous leak embolization. This is a minimally invasive procedure intended to reduce blood escaping through the identified venous pathways.

How does VHVI’s coil-and-foam approach work?

Dr. Fakhri uses coils and polidocanol foam, rather than foam alone. Depending on the anatomy shown during the procedure, he places coils in selected proximal venous pathways, often including internal pudendal vein tributaries and the periprostatic venous plexus, also known as the plexus of Santorini. He then injects polidocanol foam to treat the targeted venous pathways and finishes with coils in the proximal deep dorsal vein.

The coils are intended to block selected drainage routes and help limit foam from flowing beyond the intended treatment area. The exact vessels treated depend on each patient’s anatomy.

Use of polidocanol injectable foam for penile venous leak is outside its FDA-approved indications. Dr. Fakhri will discuss the proposed procedure, its potential risks, alternatives, and the limits of the available evidence with you before treatment.

Schedule a consultation

If you have persistent ED and want to understand whether arterial disease, venous leak, or both may be involved, contact VHVI to schedule a consultation. We can review your history and discuss which testing and treatment options are appropriate for you.

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