The effect of 2 cuff design changes on the mechanical reliability of the current AS800 artificial urinary sphincter was assessed in 126 patients. The surface-treated cuff was introduced in 1983 and the narrow-back design was introduced in 1987. Mean followup for the surface-treated cuff was 40 months, while that for the narrow back was 27.2 months. The incidence of cuff leaks was 1.3%, while the revision rate for clinically significant pressure atrophy, in the absence of a bladder flap urethroplasty, was 2.3%. The overall revision rate for clinically significant pressure atrophy was 9%. No leaks involving the balloon or tubing occurred. The mechanical reliability of the current AS800 artificial urinary sphincter has improved significantly.