The causes and treatment of venogenic impotence are still controversial. From September 1989 to April 1991, 317 men complaining of impotence were evaluated in our Erectile Dysfunction Clinic. Seventy patients were suspected of having venous leakage, and all men had dynamic cavernosography performed. Forty-seven of these 70 men (67%) had venous leakage, and a vacuum tumescence device was recommended as initial treatment for all of them. A questionnaire was later mailed to all 47 patients. A response to the questionnaire was obtained from 45 men (96%). Twenty-nine patients had purchased a vacuum tumescence device (Osbon ErecAid). A satisfactory result was obtained in 20 patients (69%) with venous leakage. Since the use of the vacuum tumescence device is relatively safe and noninvasive, and the results are as good as or better than venous ligation, we recommend its use as the initial treatment of venogenic impotence until a consistently reliable treatment for this condition is found.