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There is a lack of information pertaining to the postoperative evaluation in patients with artificial urinary sphincter (AUS) implants who complain and continue to have urinary incontinence (UI). Two types of UI can occur after the activation of an AUS device these are: early or initial (persistent) UI, and delayed (recurrent) UI. There are many causes of persistent and/or recurrent UI and these can sometimes overlap. The potential causes include improper and/or accidental operation of the pump-control unit, overactive bladder, cuff atrophy, cuff erosion, improper cuff size and pressure-regulating balloon unit, as well as device malfunctions. The diagnostic evaluation in men with persistent and/or recurrent UI after AUS implantation requires sufficient understanding of the AUS mechanics and is a step-wise and logical process with careful history and thorough clinical evaluation. Once a diagnosis is made, patients should be counselled and appropriate treatment instituted.