The artificial urinary sphincter (AUS) has evolved from early urethral compression devices in the 1600s to the modern AMS 800, which remains the gold standard for surgical management of stress urinary incontinence (SUI). This chapter reviews the historical development of AUS, from primitive clamps to contemporary hydraulic devices, and highlights the technological refinements that have improved safety, durability, and patient outcomes. Modern devices, including the AMS 800, ZSI 375, VICTO, ContiClassic/ContiReflex, FlowSecure, and Periurethral Constrictor, are discussed with attention to their design, function, and clinical outcomes. Indications, patient selection, and outcomes data are reviewed, emphasizing the role of AUS in post-prostatectomy incontinence and refractory cases. Future directions, including the development of smart AUS systems with personalized and remote-controlled functionality, are also explored.