I will answer your questions in turn
How does venous leak develop?
WebMD in the linked article in your question states how Venous Leak can happen
It may happen with vascular disease.
Vascular diseases affect blood vessels. They lower blood flow to organs such as the heart, brain, and kidneys. If they cut blood flow to the penis, they can cause erectile dysfunction. These diseases may be the cause of ED in as many as 50% to 70% of men who have it.
It’s also linked to diabetes, Peyronie's disease (a buildup of scar tissue in the penis that leads to curved, painful erections), some nerve conditions, and even severe anxiety.
What is done to diagnose someone with venous leak?
For medical diagnosis, WebMD states that as well as your medical and sexual history, your doctor will check your penis and testicles to make sure they look normal and their nerves work as expected. He may also look for hair loss and larger-than-normal breasts. Both of these can be signs that you have a hormone problem.
He may also check your pulse at your wrists and ankles to see whether your blood flow is normal,listen to your heartbeat to make sure it sounds right, and take your blood pressure.
Based on your physical exam, as well as looking at your medical and sexual history, your doctor may want to order certain blood or urine tests, or even an overnight erection test.
If it looks more likely that a mental or emotional issue is the source of the problem, your doctor will ask you standard questions about your mental well-being. They help him/her check for depression, anxiety, and other common causes of erectile dysfunction.
Are there effective treatments, such as surgery?
WebMD at this page gives a list of possible treatments depending on the results of the medical examination, including:
- Counselling - for depression or anxiety related problems
- Medications - Tadalafil, Sildenafil etc.
- Pumps - vacuum devices
- Surgery
At what stage surgery is needed?
This as a last resort (if all else fails). These can include placement of an implant (prosthesis) in the penis or vascular reconstruction surgery to improve blood flow to or reduce blood leakage from the penis and surrounding structures. This procedure works in very few cases.