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Background: The artificial urinary sphincter (AUS) has become the gold standard to treat severe stress urinary incontinence in men. The traditional placement of an AUS requires two incisions. The cuff is placed through a perineal incision and the reservoir and pump are placed via an inguinal incision. The implantation of an AUS is also possible via a single penocrotal approach. Objectives: The objective is to demonstrate that the penoscrotal approach is not inferior to the perineal approach. Methods: Retrospective review of a single surgeon database between 1 October 2014 and 1 May 2019 was performed. A total of 40 patients have undergone implantation of an AUS via a penoscrotal incision at the Jessa Hospital in Hasselt, Belgium. The outcome of patients was followed for an average of 31,3 months for adverse outcomes. Results: A primary AMS 800 sphincter was placed in 40 patients via a penoscrotal incision. The average age was 72 years. The average operating time was 35 minutes. The average cuff size was 4 cm. Incontinence etiology was due to radical prostatectomy in 27 patients. Nine subjects had radical prostatectomy plus radiotherapy. Four patients developed severe stress incontinence after a transurethral resection of the prostate and one patient after an open prostatectomy for benign disease. The final patient underwent resection of a chordoma at the level of the sacrum which caused SUI. Postoperatively on day one, three patients developed urinary retention. These patients all responded to 24 hours of catheterization. Three patients (7.5%) required a revision: one for mechanical failure of the reservoir and two patients required downsizing of the cuff. An explant of the prothesis was necessary in two other patients (5%): one patient developed erosion of the cuff two years after the operation and one patient developed progressive metastatic prostate cancer with local involvement. Finally, two patients required permanent deactivation of the sphincter: one because of increasing Alzheimer dementia and inability to use the sphincter safely and one patient because of persistent radiocystitis. There were no infections of the prothesis. Preoperatively there was an average of 6 pads per day, ranging from 1 to 10 pads per day. After activation of the sphincter, 33 patients (82.5%) were continent according to the ‘social’ definition of continence (completely dry or no more than one pad per day) (5). Three patients (7.5%) were improved and required two to four pads per day. Before implantation of the sphincter, an average of five pads a day was required. The remaining four patients are the explants and the deactivations. Conclusions: We conclude that the implantation of an AUS via a penoscrotal approach is not inferior to the perineal approach. In our opinion, the penoscrotal approach has many advantages: it offers easier and quicker exposure of the urethra; it only requires one incision; and a significantly shorter operation time. While we, unfortunately, did not track pain medication usage in our patients, we have the distinct impression that the post-operative course following scrotal incision is experienced as less painful than the perineal incision. These advantages ultimately result in a reduced infection risk without loss of quality and outcome.