Quick answer
Penile venous leak (cavernous venous insufficiency) is a frequent organic cause of erectile dysfunction, characterised by abnormal venous drainage that prevents the erection from being maintained. Percutaneous embolization of the responsible veins specifically treats this cause.
What is a penile venous leak?
Penile venous leak (or cavernous venous insufficiency) is an organic cause of erectile dysfunction. Blood drains abnormally from the corpora cavernosa during erection, preventing sufficient pressure from being maintained despite a normal arterial inflow. It is distinct from arterial and psychogenic causes.
Diagnosis relies on cavernosography CT (intracavernous contrast injection plus CT), which shows the leaking vein or veins. Treatment by percutaneous embolization selectively occludes the abnormal veins, via the dorsal vein of the penis, under general anaesthesia, as day surgery.
Important: this condition is distinct from varicocele. A full prior work-up is essential to confirm the venous origin of the erectile dysfunction (cavernosography CT).
Embolization of penile venous leaks at a glance
| Criterion | Venous leak embolization |
|---|---|
| Effect on erection | Improvement in 60 to 75% of cases in the medium term |
| Indication | Erectile dysfunction due to a venous leak confirmed on cavernosography CT or Doppler ultrasound, resistant to medical treatment (PDE5 inhibitors) |
| Anaesthesia / stay | General anaesthesia, day surgery, return to activities in 48 h |
| Scar | None, percutaneous venous puncture |
| Recurrence | Possible; a new embolization or another treatment remains an option |
| Coverage | Reimbursed by the French health insurance at Cochin AP-HP, no extra fees |
Data validated by the team of Pr Anthony Dohan, Interventional Radiology Department, Cochin Hospital AP-HP, Université Paris Cité. Cochin is one of the few French centres performing this technique.
Essential prior work-up
- Dynamic penile Doppler ultrasound after intracavernous injection (papaverine) to confirm the leak.
- Cavernosography CT: contrast injection into the corpus cavernosum plus CT to show the leak.
- Consultation with a urologist or andrologist for a full assessment.
- Hormonal (testosterone) and general vascular work-up.
The procedure
- Performed under general anaesthesia, as day surgery.
- Access via the dorsal vein of the penis (or retropubic route depending on anatomy).
- Opacification of the draining veins under fluoroscopic guidance.
- Injection of a selective embolic agent to occlude the abnormal veins.
- Monitoring for 1 to 2 hours. Return home the same day.
After the procedure
- Light activities resume 24 to 48 hours later.
- No sexual activity for 2 to 3 weeks.
- Clinical follow-up at 3 months to assess the result.
Expected benefits
- Improved erection rigidity in 60 to 75% of cases
- Minimally invasive treatment, an alternative to surgery
- Day surgery under general anaesthesia, no incision
- Repeatable in case of partial recurrence
Possible complications
| Complication | Description | Frequency |
|---|---|---|
| Haematoma at the puncture site | Resolves spontaneously | < 3% |
| Recurrence of the venous leak | A new embolization is possible | 30-50% |
| No improvement | Discussion of alternatives (PDE5 inhibitors, injections, prosthesis) | ~50% |
Limits of the treatment
The success rate (60 to 75%) is lower than for other embolizations, and recurrence of the venous leak is frequent (30-50%); a new embolization then remains possible. Associated non-venous causes (arterial, hormonal, psychogenic) are not treated by this technique. In every case the other treatment options remain available.
Other techniques and alternatives
- PDE5 inhibitors: first-line treatment, possibly continued in combination.
- Intracavernous injections: effective regardless of the venous cause, but to be repeated at each intercourse.
- Surgical venous ligation: more invasive, with long-term results comparable to embolization.
- Penile prosthesis: last resort if other treatments fail.
If you finally decline treatment: you remain entirely free in your decision. Your physician will discuss the alternatives with you according to your situation.
Book an appointment or request an opinion
Contact us / request a medical opinion by email. A referral letter is recommended. Secretariat: Monday to Friday, 8:30 to 17:30. Cochin Hospital, Achard building, 1st basement, 27 rue du Faubourg Saint-Jacques, 75014 Paris.
Venous pre-consultation questionnaire → · Embolization for erectile dysfunction → · How to restore a good-quality erection? → · Penile venous leak centre → · Vascular causes of erectile dysfunction →
Why this page is trustworthy
Written by the Interventional Radiology team of Cochin Hospital AP-HP, Université Paris Cité, and reviewed by an interventional radiologist of the department. Last updated: July 2026.
Frequently asked questions
Is embolization of venous leaks effective?
Yes, in well-selected patients (leak confirmed on cavernosography CT). Erection improves in 60 to 75% of cases in the medium term. Selection by precise work-up is decisive.
Venous leak or classic erectile dysfunction: what is the difference?
Venous leak is a specific organic cause: blood escapes from the corpora cavernosa through abnormal veins. It is suspected when medications (Viagra, Cialis) are ineffective, and confirmed by cavernosography CT.
How is a penile venous leak diagnosed?
By a pharmaco-induced penile Doppler ultrasound and above all a cavernosography CT, which shows the leaking veins and allows the embolization to be planned.
Is it covered by insurance, and is it painful?
Covered 100% by the French health insurance at Cochin AP-HP, with no extra fees. Performed under general anaesthesia as day surgery, with a return to activities within 48 hours.
Are venous leak and varicocele the same thing?
No. Varicocele concerns the veins of the spermatic cord (fertility). Penile venous leak concerns the corpora cavernosa (erection). Both can be treated by embolization at Cochin AP-HP.
Is a referral letter necessary?
No letter is mandatory, but it is welcome if you have one. Use the contact form of the site.