Below ive quoted form a study that looked at vl and identified it as a secondary event due to changes in the structure of the TA, ie very similar to what happens with peyronies.
Let me know if this gives you any kind of insight.
Cheers
"Failure of adequate venous occlusion has been proposed as one of the most common causes of venogenic impotence [3]. The cause of veno-occlusive dysfunction is not exactly known. It may result from several possible pathophysiologic processes which include the presence of large venous channels draining the corpora cavernosa, Peyronie's disease, diabetes and structural alterations in the fibroelastic components of the trabeculae, cavernous smooth muscle and endothelium [4-6].
The treatment of venogenic ED (VED) is penile veins ligation if the known less invasive measures such as intracavernous injection of vasodilators fail to induce adequate erection [7]. It seems that these treatment modalities deal with a secondary effect rather than the primary etiological factor of the venogenic ED; therefore the results of treatment are unsatisfactory [7]. We hypothesized that the cause of venous leakage during erection is an atrophy of the tunica albuginea (TA) with a resulting TA subluxation and redundancy. This hypothesis was investigated in the current study.
The current study may shed some light on the pathogenesis of VED. The venules that drain the sinusoidal spaces and the smooth muscles of the penis coalesce as they approach the CC periphery and form the subtunical venular plexus [8]. Small veins exit from the plexus through the TA as the emissary veins, and drain into the circumflex veins or directly into the deep dorsal vein. The position of the subtunical venular plexus between the sinusoids and TA allows for their compression and occlusion as the smooth muscle and sinusoids relax and expand against the TA during tumescence [8-11]. This occlusion acts to trap the blood within the penis. The loss of this veno-occlusive function leads to leakage of blood from the penis with a resulting impotence [8-11]. The TA, being composed mainly of collagen fibers, is relatively noncompliant. It occludes the penile venous outflow through compression of the subtunical venular plexus and the perforating emissary veins passing through it. The integrity of the fibroelastic tissue of the TA and CC apparently plays a significant role in the erectile process [12]."
"The study has shown that during erection, the ICP of patients with VED was significantly lower than that of the controls. Furthermore, the collagen fibers of the TA exhibited degenerative and atrophic changes that presumably lead to TA subluxation and floppiness. These TA changes seem to explain the cause of the lowered ICP of the patients during erection which apparently results from loss of the TA veno-occlusive mechanism. The cause of atrophic changes and subluxation of the TA needs to be studied"
Caution not much success reported by patients with this treatment (see forum for vein ligation):
The treatment of venogenic Erectile Dysfunction (VED) is penile veins ligation if the known less invasive measures such as intracavernous injection of vasodilators fail to induce adequate erection [7].
Yep thats the exact point that study is also making Tony. That vein ligation is trying to fix the symptom ie vl / but its got nothing to do with the cause. Hence why its usually unsuccessful.
All current ED treatments (if not all, most of them anyhow) deal with the symptom rather than eliminating its causes.
What's the point of this thread anyway? Confirming that we're all looking for an effective way to get rid of the plaques and magically regrow new TA's portions (i.e. stating the obvious)?
Well my thinking is inquiring and understanding the cause of what is messing up the structures of TA fibers will get us closer to finding a solution that is more viable than just dabbling around with symptoms.
Hollistic solutions like keto diet and fasting and how they affect and improve mitochondria function i think is the type of stuff im trying to look into more. And also would love for others who are more informed than me right now to add more info.
Plus also the article points out that venous leak is not leaky veins as the primary cause but issues with the structure of the TA. And a lot of people who have symptoms of vl would not know this hence i thot it would help peeps out if they understood this distinction.
I would try TRT before doing any kind of surgery for venous leak.
Find a good functional medicine physician.