Penile venous surgery might not be considered an appropriate treatment for erectile dysfunction (ED) because of disappointing functional outcomes and unacceptable, seemly unavoidable, penile deformity. We report results of a refined penile venous stripping method in patients with veno-occlusive dysfunction (VOD). From 2000 to 2003, 341 of 467 men with ED were diagnosed with VOD via cavernosography and Doppler sonography. Patients were excluded from undertaking cavernosography if they had an untreated chronic systemic disease. Patients who had undergone the first penile venous surgery in other institutes were also excluded from this study because of the protracted surgical time and unpredictable functional outcomes, because severe fibrosis may prevent patients from completing penile venous removal. Of these 341 men, 178 were treated with a refined venous stripping surgical method (surgery group) and 163 patients were treated without this surgery (control group). In the surgery group, 167 were available for long-term follow-up using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) scoring system. The operative time ranged from 2.1 to 5.0 hours. The follow-up period ranged from 5.1 to 8.2 years, with an average of 7.7 +/- 1.4 years. The difference between the preoperative (9.7 +/- 3.9) and postoperative (21.6 +/- 2.8) IIEF-5 scores was significant (P < .001). Overall, 90.4% of the surgery group (151 of 167) reported improvements after surgery. A significant decrease in IIEF-5 scores (10.4 +/- 3.8 vs 7.9 +/- 3.2, P < .001, n = 121) during the same period of follow-up was, however, noted in the control group. This refined penile venous stripping surgery delivered favorable results and is a viable alternative for treating VOD.