AMS 700CX Research Articles

Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction

BackgroundMost of the published literature addressing the satisfaction postinflatable penile implant (IPP) placement includes non-validated surveys. AimThe study aims to report the survey outcomes of the English version of The QoLSPP and to evaluate the different factors that could influence these results. MethodsPatients who underwent inflatable penile implant placement from January 2017 to December 2019 received a survey by phone and had a visit scheduled no sooner than 27 months after surgery. In the clinic, they were inquired about the penile size and underwent measurements of postoperative penile length and diameter. The survey responses were rated from zero to 5 following QoLSPP, and answers ≥3 were considered positive. An evaluation of the factors influencing the quality-of-life score of patients post-IPP placement was performed. Variables included age (<60, 60–70, >70), BMI classification, Charlson Comorbidity Index, diabetes diagnosis, implant type (AMS 700CX vs Titan), ED etiology, revisions, postoperative time in months (<30, 30–40, >40) and preoperative vs postoperative penile dimensions in those who attended the clinic. OutcomesThe primary outcome was to obtain accurate patient-reported satisfaction after inflatable penile implantation. ResultsWithin the timeframe, 542 patients underwent first-time IPP placements. Of that group, 322(n) completed the surveys, and 109 patients attended the clinic to compare preoperative vs postoperative dimensions. Of note, 67 (61.4%) and 54 (49.4 %) demonstrated enlargement in length and diameter, respectively. Conversely, 12 (11%) and 4 (3.7%) experienced a shortening in length and girth. We found 66 (60.5%) patients who complained about a penile size decrease after the intervention. The survey had a positive response in 93.1% of the cases. There were no statistically significant differences in positive responses concerning the variables investigated. The subpopulation analysis of the penile-sized group neither showed response variations. Clinical implicationsThe investigation allowed a better understanding of patient-reported satisfaction post-IPP placement. Strengths & LimitationsThe performance of all the procedures in a high-volume center by a single surgeon limits its generalization. ConclusionThe overall results after IPP surgery are positive in most patients who underwent the procedure and the variables investigated did not influence the overall outcomes of the QoLSPP survey in the study.Luna E, Rodriguez D, Barrios D, et al. Evaluation of Quality of Life After Inflatable Penile Implantation and Analysis of Factors Influencing Postsurgery Patient Satisfaction. J Sex Med 2022;19:1472–1478.

A Comparative Study Between 2 Different Grafts Used as Patches After Plaque Incision and Inflatable Penile Prosthesis Implantation for End-Stage Peyronie's Disease

BackgroundAlthough many grafts have been used for plaque incision with grafting (PIG) and penile prosthesis (PP) implantation, there is no evidence that favors 1 specific graft over another. AimTo compare fibrin-coated collagen fleece (TachoSil; Baxter International, Deerfield, IL, USA) with porcine small intestinal submucosa (SIS; Cook Biotech, West Lafayette, IN, USA) as grafts. MethodsFrom January 2007 to January 2015, 60 non-randomized consecutive patients affected by end-stage Peyronie disease underwent PIG and PP implantation (AMS 700CX; Boston Scientific, Marlborough, MA, USA). All patients underwent preoperative penile dynamic duplex ultrasound. All procedures were performed by the same surgeon. Patients were divided in 2 different groups according to the graft used to cover the albuginea defect. SIS was used for grafting in 34 patients (group A) and TachoSil was used in 26 patients (group B). OutcomesOverall hospital stay, operative time, 5-point Likert hematoma scale, visual analog scale, incidence of postoperative complications, and PP mechanical failure were selected as outcome measures. Functional outcomes were assessed through validated questionnaires (International Index of Erectile Function, Erectile Dysfunction Inventory of Treatment Satisfaction, and Sexual Encounter Profile questions 2 and 3) preoperatively and 3, 6, and 12 months postoperatively. ResultsThe patients' median age was 63 years. No statistically significant differences were detected between groups for age and type and degree of curvature (median = 65°). Average follow-up was 35 months. No major intraoperative complications were reported. The average operative time was 145 minutes for group A and 120 minutes for group B. No statistically significant differences between groups were detected for postoperative complications. Only 3 patients developed a major postoperative complication requiring a 2nd surgical intervention: 1 patient in group A for mechanic failure and 1 patient in group A and 1 in group B for inflatable PP infection. Multivariate statistical analysis showed no significant difference for all variables analyzed between the 2 groups, except for operative time, which was significantly shorter for group B. Clinical ImplicationsTachoSil could represent a valuable option for grafting, considering its advantages in operative time and cost compared with SIS. Strengths and LimitationsLong-term follow-up represents a strength factor. Main limitations are the non-randomized nature of the study and the small number of patients. ConclusionsTachoSil seems to represent an effective solution for grafting after PIG and PP implantation. However, additional studies are warranted to confirm our results.Falcone M, Preto M, Ceruti C, et al. A Comparative Study Between 2 Different Grafts Used as Patches After Plaque Incision and Inflatable Penile Prosthesis Implantation for End-Stage Peyronie's Disease. J Sex Med 2018;15:848–852.

Long-term patient-reported satisfaction with different inflatable penile prosthesis: Comparison between AMS 700CX and Coloplast Titan

IntroductionErectile dysfunction (ED) is one of the most prevalent male sexual disorders worldwide. When conservative treatment is unsuccessful, contraindicated or causes unacceptable side effects penile prosthesis implantation is a definitive option for the management of ED. Although considered a third-line therapy, it achieves the highest satisfaction rates as compared with non-surgical treatment. Three-piece inflatable penile prothesis (IPP) represents the most sophisticated implantable device, AMS 700CX™ and Coloplast Titan® being the two most commonly used. Although there are several studies evaluating patient satisfaction with either model, there is little published data comparing both models. MethodsWe have compared overall patient satisfaction in 55 patients submitted to either 700CX™ or Titan® implantation. The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used to access patient satisfaction. ResultsPatient mean age and follow-up time were 59.1 years and 57.9 months respectively. There was no difference in EDITS score between 700CX™ and Titan® IPP (77.2±12.1 versus 77.5±16.6 respectively, p=0.956). ConclusionOverall patient satisfaction as assessed by EDITS questionnaire was not different between 700CX™ and Titan®.

Surgical Outcomes of Erectile Implants After Phalloplasty: Retrospective Analysis of 95 Procedures

IntroductionThe creation of a neophallus is a complex surgery that must meet functional and esthetic requirements. It is a long and demanding surgical process whose final stage consists of the implantation of a rigid or inflatable material that can be used to reproduce an erection. Data in the literature are scarce, with only the pioneering series present, which includes the use of the first devices and techniques. AimTo report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft. MethodsThis is a retrospective hospital-based analysis of all patients with phalloplasty who underwent implantation of an erectile prosthesis from March 2007 to May 2015. Factors associated with complications were investigated by multivariate logistic regression analysis. Main Outcome MeasuresEarly-onset (during the first month after surgery) and late-onset complications, including erosion, infections, malpositioning, and dysfunction. ResultsSixty-nine patients were included in the study and 95 procedures were analyzed. After a median follow-up of 4 years (minimum = 169 days, maximum = 6.1 years), the original prosthesis was still in place in 43 patients (62.3%). Patients underwent phalloplasty after female-to-male transsexualism (n = 62, 89.9%), malformation (n = 4, 5.8%), or trauma (n = 3, 4.3%). The proportions for the different types of phalloplasty were 58% for forearm free flap phalloplasty (n = 40), 33.3% for suprapubic phalloplasty (n = 23), and 7% for other (n = 6). The erectile prostheses used were the two-piece AMS Ambicor (n = 71, 74.7%), the Ambicor with a vascular graft (n = 19, 20.0%), and the AMS 700CXR, AMS 700CX, or AMS600-650 (n = 5, 5.2%). There were no early-onset complications in 89 procedures (93.7%) and, when present, they were always related to infection (n = 4, 4.2%). Late-onset complications were erosion (n = 4, 4.2%), infection (n = 4, 4.2%), dysfunction (n = 10, 10.5%), and malpositioning (n = 12, 12.6%). No significant difference was observed for malpositioning (12.7% vs 10.5%, P = .87) and dysfunction (7.0% vs 10.5%, P = .78) between the AMS Ambicor prosthesis and the Ambicor prosthesis with a vascular graft. ConclusionThis study provides updated data on complications after the implantation of erectile implants. Multicenter studies, including the evaluation of patient satisfaction, are needed to increase our understanding of factors associated with the outcomes.

Erectile Dysfunction

Erectile Dysfunction

1800 PENILE PROSTHESIS INSERTION IN GENDER DYSPHORIA- LONG TERM RESULTS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Peyronie's Disease/Surgical Therapy1 Apr 20111800 PENILE PROSTHESIS INSERTION IN GENDER DYSPHORIA- LONG TERM RESULTS Donato Dente, Giulio Garaffa, Suks Minhas, Andrew Nimal Chistopher, and David Ralph Donato DenteDonato Dente Rome, Italy More articles by this author , Giulio GaraffaGiulio Garaffa London, United Kingdom More articles by this author , Suks MinhasSuks Minhas London, United Kingdom More articles by this author , Andrew Nimal ChistopherAndrew Nimal Chistopher London, United Kingdom More articles by this author , and David RalphDavid Ralph London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2172AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to report the results of penile prosthesis implantion in patients with gender dysphoria who have had a previous phalloplasty. METHODS Between 2000 to 2010, 146 patients (age 22 – 59 yrs, mean 38.5 yrs) with Gender Dysphoria had a penile prosthesis inserted into their phalloplasty. The types of phalloplasty included the forearm free flap (n=87), an abdominal phalloplasty (n = 48) and a combination of the above in 11 patients. The prostheses used were the AMS 700CX in 137 pts and the AMS Ambicor in 9 pts. The resevoir component and a single testicular prosthesis had been inserted 3 months earlier. A single cylinder was used in 104 patients and 2 cylinders, when the phallus was bulky, in 42 patients. A vascular graft, impregnated with silver to reduce infection, was used to form a cap and sock around the cylinder to aid with anchorage to the pubis and to reduce the chance of distal erosion. The surgical results and complications were recorded. RESULTS A prosthesis was inserted in all patients without intraoperative complications. After a mean follow up of 20 months (range 7 – 123 months), a successful surgical result was declared with the prosthesis in a good position and the patient being able to cycle the device in 137 patients, although only 69 patients (50%) were having sexual intercourse. The revision rate was 31% to include: infection in 23 patients (16%), erosion 9 pts (6%), mechanical failure 33 pts (24%) and elective readjustment of components in 28 patients. Some patients had multiple revisions. CONCLUSIONS The insetion of a penile prosthesis into a phalloplasty technically allows enough rigidity to have penetrative sexual intercourse. However the patients must be informed of the shorter device life expectancy and the high complication and revision rate. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e723 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Donato Dente Rome, Italy More articles by this author Giulio Garaffa London, United Kingdom More articles by this author Suks Minhas London, United Kingdom More articles by this author Andrew Nimal Chistopher London, United Kingdom More articles by this author David Ralph London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

MP-09.2: Mechanical Reliability of the Newly Enhanced AMS 700CX Penile Implants

Parylene coating was added to the silicone layers of the AMS 700 CX penile prosthesis cylinders in January 2001. The coating was placed on non-tissue contacting silicone surfaces to increase lubricity, reduce friction and silicone wear. We compare mechanical reliability of the original and Parylene enhanced AMS 700 CX in a large single surgical group series

Penile Implantation in Europe: Successes and Complications with 253 Implants in Italy and Germany

Results for prosthesis implantation from everyday clinical practice within Europe are few. This report provides data on the most commonly used penile prostheses (the American Medical Systems [AMS] series). The study aimed to assess, retrospectively, complications and patient satisfaction with AMS penile implants in 253 consecutive patients with erectile dysfunction from three European centers. Pre, intra- and postoperative data were obtained from chart review, with a mean follow-up of 60 months; 200 patients were available for evaluation. Patient satisfaction data were collected using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Complications and patient satisfaction were assessed. Patient satisfaction was evaluated using a standardized assessment tool (the modified EDITS questionnaire). Major postoperative complications occurred in 40 (20%) patients, including 9 (22.5%) prosthesis infections, 18 (45%) mechanical failures, and 13 (32.5%) erosions. Patient satisfaction with the AMS 700CX, AMS Ambicor, and AMS 600-650 was 97%, 81%, and 75%, respectively; dissatisfaction was 0%, 5%, and 6%, respectively. Partner satisfaction with the AMS 700CX, AMS Ambicor, and AMS 600-650 was 91%, 91%, and 75%, respectively; dissatisfaction was 0%, 5%, and 6%, respectively. Erections were more natural (harder) than before with the AMS 700CX, AMS Ambicor, and AMS 600-650 in 91%, 85%, and 88%, respectively; hardness was the same as before in 9%, 15%, and 13%, respectively; no erections were less hard than before. Postoperative complications differed from those reported in the literature, while patient satisfaction rates were roughly similar. The reporting of specific data for different implant types, plus the use of standardized assessment tools for patient satisfaction is significant as in the future, it will allow comparison of data between centers performing penile prosthesis implants using these devices.

Outcomes and Satisfaction Rates for the Redesigned 2-Piece Penile Prosthesis

We evaluated long-term viability, quality of life and satisfaction with the redesigned 2 piece Ambicor inflatable penile prosthesis. This device underwent revision of the rear tip extender and reinforcement of the pump tubing connection to decrease fluid leak failure in 1998. In this retrospective analysis we evaluated 146 men with erectile dysfunction at 2 centers who underwent device implantation between June 1999 and October 2004 with the redesigned prosthesis. Patient information forms were completed, including patient history, surgical information and revision data. Patients were mailed a modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, a modified Erectile Dysfunction Inventory of Treatment Satisfaction Partner survey and a questionnaire regarding pertinent inflatable penile prosthesis questions. A total of 146 men with a mean age of 58.7 years (range 25 to 78) were evaluated after inflatable penile prosthesis placement. Time from implant to followup was 3 to 73 months (mean 38). Only 1 device (0.7%) was removed due to infection. One implant (0.7%) was replaced due to fluid loss and 1 (0.7%) was revised due to improper sizing. Kaplan-Meier life table analysis indicated that the percent of patients free from reoperation was 99.2% at 12 months, 99.2% at 36 months and 91% at 48 months or greater. Of the 101 subjects completing the survey the average patient used the prosthesis 5 times monthly and 88.9% reported continued use. Of the patients 91% said that it was easy to use and 95% had little to no trouble learning to use it, while 84% stated that the inflatable penile prosthesis provided good to excellent rigidity for coitus. Overall patient and partner satisfaction was 85% and 76%, respectively. Of the patients 86% said that they would recommend the prosthesis to friends or if need be undergo the procedure again. The redesigned Ambicor 2-piece penile prosthesis appears to be safe and effective. It is associated with a low rate of revision as well as high patient and partner satisfaction.

LONG-TERM FOLLOWUP OF TREATMENT FOR PEYRONIE’S DISEASE: MODELING THE PENIS OVER AN INFLATABLE PENILE PROSTHESIS

We originally reported inflatable penile implants used to treat impotence in patients with Peyronie's disease in 1993. We now present a historical prospective study of 104 patients in whom the modeling procedure was used to correct Peyronie's curvature after implantation with the Mentor Alpha 1dagger and AMS 700CXdouble dagger penile prostheses. We compared revision-free survival experience of these implants with 905 similar implants in men with nonPeyronie's disease. The reasons for revision were classified as mechanical failure, patient dissatisfaction, infection and medical causes, including reoperation for straightening. Overall and cause specific revision-free survival in the 2 study cohorts was compared. Maximum followup was more than 12 years and average followup was more than 5. No significant difference in device survival was observed in the 2 study cohorts in 5 years. Similarly each prosthesis provided the same permanent straightening without the need for revision. In Peyronie's disease cases mechanical survival of the Mentor Alpha 1 was superior to that of the AMS 700CX (p = 0.0270). There was no significant difference in mechanical reliability of the devices in nonPeyronie's disease cases. Implantation and modeling appear to provide permanent straightening without an increase in revisions. In the nonmodeled group there was no significant difference in mechanical reliability of the AMS 700CX or Mentor Alpha 1. In modeled cases the Mentor Alpha 1 appeared less likely to fail mechanically than the AMS 700CX when followed more than 5 years. Based on this single series modeling may predispose the AMS 700CX to earlier mechanical failure.

EFFICACY, SAFETY AND PATIENT SATISFACTION OUTCOMES OF THE AMS 700CX INFLATABLE PENILE PROSTHESIS: RESULTS OF A LONG-TERM MULTICENTER STUDY

We performed a long-term multicenter study of the AMS 700CX 3-piece inflatable penile prosthesis, focusing on longevity, morbidity and patient satisfaction in men implanted up to 134 months with a median followup of 47.7 months. We performed a large scale retrospective multicenter study in 2 phases. Phase 1 was a medical record review of 372 men who underwent implantation with the AMS 700CX penile prosthesis from 1987 to 1996 by 7 frequent penile prosthesis implanters. Phase 2 included a structured telephone interview of 207 patients by a neutral observer. For the 372 men in phase 1 mean device mechanical reliability plus or minus standard deviation was 92.1% + or - 3.3% after 3 and 86.2% + or - 4.6% after 5 years. Patient age was 21 to 79 years (mean 57.6 + or - 11.0) at implantation. The etiology of erectile dysfunction was vascular in 27.7% of the cases, Peyronie's disease in 16.9%, diabetes mellitus in 12.9% and radical surgery in 11.6%. Of the men 55.6% received previous treatment for erectile dysfunction. Postoperative infection and device malfunction developed in 3.2% and 17.5% of the cases, respectively. Of the 207 men interviewed in phase 2, 86% still had an AMS 700CX penile prosthesis implanted, including 87.1% with erection suitable for coitus. Currently 79% of those with a device use it at least twice monthly and 88.2% would recommend an implant to a relative or friend. The AMS 700CX penile implant produced suitable erection and excellent patient satisfaction at long-term followup in the majority of men. Implant reliability is excellent and postoperative morbidity is low.

INTRAURETHRAL APPLICATION OF ALPROSTADIL IN PATIENTS WITH FAILED INFLATABLE PENILE PROSTHESIS

Many men who underwent penile prosthesis implantation before the advent of oral and injection therapy present for replacement of a malfunctioning prosthesis but choose not to undergo revision surgery because of personal, medical or reimbursement issues. Others with normally functioning prostheses report significant difficulties with "cold glans," and they and their partners observe decreased engorgement and temperature of the glans penis with the inflated penile prosthesis, despite adequate stimulation. Intracorporal injection therapy is contraindicated in any patient with a penile prosthesis and use of a vacuum erection device may result in prosthesis cylinder rupture. In these patients intraurethral application of alprostadil may restore prosthesis function and permit satisfactory intercourse. We evaluate the efficacy of a medicated urethral system for erection (MUSE) using alprostadil to restore function for men with a failed prosthesis, and improve glans penis temperature sensation and engorgement for those with a functioning prosthesis. From February 1997 to February 1998, 28 men 47 to 81 years old (mean age 61.2) with a penile prosthesis were treated with alprostadil. Of the patients 11 had penile prosthesis failure (group 1) and 17 reported decreased glans penis engorgement (group 2). In 18 cases erections were observed at the clinic. Doses of alprostadil varied from 250 to 1,000 microgm. (mean 566). Of the 28 patients 23 had a response to alprostadil. Erections were sufficient for intercourse in 7 of 11 group 1 patients, and 10 of 17 group 2 were satisfied with treatment. There was no device specific morbidity but 12 men discontinued use of alprostadil because of penile pain. A significant or excellent response was noted in 10 of 18 men observed at the clinic. Intraurethral alprostadil may be used to restore or improve function of a penile prosthesis in patients with a malfunctioning device or lack of glans penis engorgement, with low expected morbidity.

Efficacy and Safety of Outcomes of the AMS 700CX Inflatable Penile Prosthesis

Efficacy and Safety of Outcomes of the AMS 700CX Inflatable Penile Prosthesis

Penile prosthesis implantation in the treatment of Peyronie's disease.

This study was undertaken to evaluate the results and complications of penile prosthesis implantation in patients with erectile dysfunction caused by Peyronie's disease. Men undergoing surgical intervention for erectile dysfunction caused by Peyronie's disease at the University of North Carolina School of Medicine were reviewed. Patients included 30 men aged 29-64 (mean = 49.6) with a duration of Peyronie's disease from 12-72 months (mean = 31.4 months). All men had palpable Peyronie's plague, significant penile curvature and plaque formation. All patients underwent implantation of AMS 700CX penile prostheses from 1993 to 1997. Penile straightening was carried out using modeling in 28 (93%) while plaque incision was necessary in 2 men (7%). All patients had a resultant straight penis with functional penile implant. There were no patients who suffered penile prosthesis infection and no mechanical malfunctions were observed during the follow-up. Penile prosthesis implantation with modeling is a safe, simple, effective technique for straightening penile curvature in patients undergoing implantation of penile prosthesis for Peyronie's disease. Penile prosthesis implantation is a safe, effective, low morbidity method for restoring potency in men with male erectile dysfunction and Peyronie's disease.

Long-term Results with Hydroflex and Dynaflex Penile Prostheses: Device Survival Comparison to Multicomponent Inflatables

Purpose We compared our experience with self-contained inflatable and multicomponent prostheses during similar intervals. Materials and Methods We followed 295 patients with self-contained prostheses and 1,026 with multicomponent inflatable devices for up to 8 years. Revision rates for mechanical failure, infection or patient dissatisfaction were statistically analyzed. Results Multicomponent inflatable prostheses were superior with regard to mechanical reliability and patient satisfaction, with no difference in rate of infection. Self-contained prostheses were best replaced with the AMS 700CX* device, thus avoiding aneurysm. *American Medical Systems, Minnetonka, Minnesota. Conclusions Self-contained inflatable prostheses may be of limited value for the treatment of impotence. The AMS 700CX is the device of choice for replacement of explanted self-contained prostheses.

Mechanical reliability of AMS hydraulic penile prostheses.

The mechanical reliability of AMS hydraulic penile prostheses implanted in 203 patients from April 1985 to June 1995 were evaluated. AMS Hydroflex prosthesis showed the highest incidence of mechanical failure (18.8%; 6/32 patients) during a mean follow-up period of 94.5 (64-117) months. Mean functioning time of the prostheses until malfunction was 50 (0-100) months. Bilateral fractures at junction of rear reservior and inflation chamber were found in 3 patients. AMS Dynaflex had a failure rate of 2.4% (2/85 patients) for an average of 35.3 (1-59) months. One patient showed complete fracture of silicone ball covering the proximal end of rear reservior onto which rear tip extenders are snapped. Regarding 3-piece inflatable prosthesis, AMS 700, AMS 700CX and AMS Ultrex had failure rates of 11.1% (1/9 patients), 10.5% (2/19 patients) and 4.0% (1/25 patients) during a mean follow-up period of 116.4 (103-125), 79.0 (60-94) and 44.4 (22-57) months, respectively. The verified causes of the mechanical failures were a tiny rupture of the cylinder in one case of AMS 700, an incomplete fracture of input tube in one case of AMS 700CX and a pump malfunction in one case of Ultrex. However, none of 33 cases of AMS 700CXM showed mechanical failure for an average of 21.3 (2-43) months. Therefore, AMS 700CXM and Ultrex seem to be very reliable, and the reliability of AMS Dynaflex was much higher than that of AMS Hydroflex. However, the long-term reliability of these devices needs more time to be determined.

Long-term experience with controlled expansion cylinders in the AMS 700CX inflatable penile prosthesis and comparison with earlier versions of the scott inflatable penile prosthesis

Objectives To determine complication and survival rates of the AMS700CX penile prosthesis and to compare its reliability with earlier versions of the Scott inflatable penile prosthesis. Methods Retrospective chart review and telephone interviews were used. Results Actual 4-year survival of the AMS 7000X device was 85%, whereas earlier versions of the device had actual 4-year survival of 46% (p < 0.0001). The observed difference in prosthesis reliability could not be accounted for by differences in patient population, surgical technique, or incidence of infections. The most significant factor that contributed to improved prosthesis survival was the lack of cylinder complications (leaks and aneurysms). Conclusions The controlled expansion cylinders of the AMS 7000X penile prosthesis are a significant advance in reliable, low-morbidity surgical therapy for impotence.