In order to evaluate the long-term results of autologous venous grafts, we present an overview of patients who underwent a procedure utilizing a venous patch from the deep dorsal vein with or without combination of the cavernosal vein in treating penile deformity. From March 1995 to March 2005, a total of 85 consecutive patients with Peyronie's disease or congenital penile deviation underwent venous grafting. Tunical corporotomy was covered using transplanted venous wall sutured micro-scopically to collagen bundles of the inner circular and outer longitudinal layer of the tunica albuginea. The vein was sutured with the serosal side outward, after it had been detubularized, properly constructed and spliced together. In this cohort, 48 patients with Peyronie's disease and 37 with congenital penile deviation were respectively categorized as belonging to the Peyronie and congenital groups. All patients were evaluated pre-operatively and postoperatively with the International Index of Erectile Function (IIEF-5) scoring, angle measurement of erectile penis, satisfaction with the penile shape, and a cavernosogram which was further available in 15 patients. Histological confirmation in 5 cases was followed-up for up to 10 years. The mean angle improvement was 44.8 ± 3.6° for the Peyronie group and 37.6 ±3.8° for the congenital group. A satisfactory penile shape was achieved in 77 (90.6%) patients although 8 men (9.4%) complained of mild deviation of the penis (< 15°). Erectile function was good in 81 patients, although 6 of them had to use oral sildenafil/tadalafil post-operatively. Overall they had a mean preoperative IIEF-5 score of 19.7 ± 2.8 which increased to a mean post-operative score of 21.6 ± 2.2. The cavernosograms consistently disclosed a good penile shape. The histological confirmation showed that the donor vein retained its histological character despite the fact that perfect coalescence and lining up with the tunica albuginea were noted. The autologous vein appears to be an acceptable graft material, and the transplanted vein may have a modeling action rather than a scaffolding role in venous patch surgery on the penile tunica albuginea. Careful microsurgical manipulation is required to achieve a satisfactory, sustainable outcome.