Of 400 patients with erectile lesions Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavemosometry showed a concomitant increase of venous drainage in 38 of them. Phallo-arteriography in 22 males demonstrated occlusion of the internal pudendal artery in 21 of them. In 15 patients penile arterialization was done by interposition of a saphenous vein graft between the iliac artery and deep dorsal penile vein. In 4 of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively two thirds of the patients are doing well. Failures in 5 of them included 4 diabetic neurovascular lesions and 1 postoperative priapism.