Commentary on: Long-term experience with AMS-700 CXR inflatable penile prosthesis in high-risk patients with corporal fibrosis

The AMS 700 Controlled Expansion Restricted (CXR) inflatable penile prosthesis (IPP), introduced in 1990, represented a groundbreaking advancement in penile prosthesis design with its narrower cylinders, specifically designed for patients with significant intracorporal fibrosis or narrowing [1].This model has been a significant technical advancement in managing high-risk patients.The study under review evaluated long-term outcomes and clinical predictors of patient satisfaction following AMS-700 CXR IPP implantation in this high-risk population.It confirmed that satisfactory penile rigidity, sufficient for penetration, remains a key factor in patient satisfaction according to existing literature [2,3].However, the study highlights a notable issue: over half of the patients reported dissatisfaction due to perceived loss of penile length and girth after implantation.Interestingly, none of the patients in this study opted for cylinder upsizing, despite previous literature indicating that about 75% of patients with IPP would consider upsizing to standard diameter cylinders post-CXR IPP [4].These findings underscore the critical need for thorough counseling, careful selection, and evaluation of outcomes when placing a penile prosthesis [5].The study has several limitations, including its small sample size, retrospective design, and inherent recall and selection biases, which affect the generalizability of the results.Additionally, the short followup period (average of 5 months) and incomplete data due to patients seeking care elsewhere further constrained the study.The nonstandardized and non-validated surveys used during follow-up visits, coupled with difficulties in reaching patients for phone surveys, may have led to an underestimation of patient dissatisfaction [6].In conclusion, while this study provides valuable insights into patient satisfaction and predictive factors following CXR IPP implantation, its findings are limited by biases and the lack of extended follow-up.Utilizing validated tools like the Satisfaction Survey for Inflatable Penile Implants (SSIPI) could improve the assessment of post-implantation satisfaction and enhance our understanding of patient outcomes.