There are still controversies about the mechanism of penile erection. Arterial aspectsof impotence have received considerable attention, but just recently the venous component became wide recognized. Twenty patients with abnormal cavernosometry (flow rate over 280 mL/min) and no rigid erections (intracavernosal pressure lower than 80 mm Hg) were analyzed. Surgical ligation of the dorsal veins was performed in 12 cases, 9 of which also required ligation of the crux of each corpus cavernosum. After these ligations, erection improved sufficiently to allow satisfactory intercourse in 9 of 12 patients. Two patients became impotent after eight months of normal sexual performance. The 3 failures showed persistently high flow rates and one leakage by the aural edge which had not been ligated at surgery. In selected patients with organic impotence the venous abnormalities should be assessed routinely and dorsal veins and the aural edge of the corpus cavernosum should be ligated in an attempt to restore erectile function. © 1990.3513537Vardi, Siroky, A canine model for hemodynamic study of isolated corpus cavernosum (1987) J Urol, 138, p. 663Shirai, Determination of intrapenile blood volume using Tc-99m-labeled autologous red blood cells (1976) Tohoku J Exp Med, 120, p. 377Wagner, Erection: physiology and endocrinology (1981) Impotence: PhysiologicalSurgical Diagnosis and Treatment, , G. Wagner, R. Green, Plenum Press, New YorkAnderson, Bloom, Mellander, Hemodynamics of pelvic nerve-induced penile erection in the dog: possible mediation by vasoactive intestinal polypeptide (1984) J Physiol, 350, p. 209Lue, Hemodynamics of canine corpora cavernoua during erection (1984) Urology, 24, p. 347Wooten, Ligation of the dorsal vein of the penis as a cure for atonic impotence (1902) Texas Med J, 18, p. 325Tudoriu, Bourmer, The hemodynamics of erection at the level of the penis and its local deterioration (1983) J Urol, 129, p. 741Ebbehoj, Wagner, Insufficient penile erection due to abnormal drainage of cavernous bodies (1979) Urology, 13, p. 507Lue, Hricak, Schmidt, Tanagho, Functional evaluation of penile veins by cavernosography in papaverine-induced erection (1986) J Urol, 135, p. 479Wespes, Schulman, Venous leakage: surgical treatment of a curable cause of impotence (1985) J Urol, 133, p. 796Kelami, Infrapubic approach in operative andrology (1978) Urology, 12, p. 580Fitzpatrick, Venography of the deep dorsal venous and valvular systems (1974) J Urol, 111, p. 518Velcek, Penile flow index utilizing a Doppler pulse wave analysis to identify penile vascular insufficiency (1980) J Urol, 123, p. 669Godec, Cass, Quantification of erection (1981) J Urol, 126, p. 345Virag, Syndrome d'érection instable par insuffisance veineuse. Diagnostic et correction chirurgicale. A propos de 10 cas aver un recul moyende 12 mois (1981) J Mal Vase, 6, p. 121Puech-Leao, Reis, Glina, Reichelt, Leakage through the crural edge of corpus cavernosum(1987) Eur Urol, 13, p. 163Williams, Mulcahy, Hartnell, Kiely, Diagnosis and treatment of venous leakage: a curable cause of impotence (1988) Br J Urol, 61, p. 151