Alcock's canal releasing for pudendal artery syndrome resulting from gunshot injury

A 21-y-old man applied to hospital with a complaint of erectile dysfunction, which started soon after a gunshot injury. The entry of the bullet was at the middle right gluteal region without any exit hole. A pelvic X-ray revealed the bullet and the scattered particles. On penile Doppler ultrasonography, the peak systolic velocities (PCV) of the right and the left cavernosal arteries were 19 and 29 cm/s, respectively. Pudendal angiography revealed poor visualization of the right pudendal artery below the level of the bullet. The patient underwent a right-sided Alcock's canal releasing surgery. After the operation, on control penile Doppler ultrasonography, PCV on the right and the left cavernosal arteries were 53 and 35 cm/s, respectively. The control angiography revealed a normal right pudendal artery. The patient was fully potent 2 y after the operation. Not only the entrapment of pudendal nerve but also the pudendal artery may cause Pudendal canal syndrome. A gunshot injury may cause such a condition due to the reaction caused by the bullet. Pudendal canal decompression is a simple and effective treatment for pudendal canal syndrome.