Use of the artificial urinary sphincter to treat incontinence in children has increased over the past decade. The hydraulic fluid used in this device is radiopaque, and the radiologist is directly involved in its evaluation. Despite advances in design and surgical technique, mechanical failures and other complications occur. Our experience with 34 artificial sphincters implanted in 31 children during 1973-1983 is reviewed, giving a method of radiographic evaluation, diagnostic errors to avoid, examples of sphincter malfunction, and common complications.