Objective: The objective is to review long-term outcomes up to 30 years following the original operation, of patients having augmentation cystoplasty (AC), with or without implantation of an artificial urinary sphincter (AUS) for sphincter weakness incontinence (SWI). Patients and Methods: A total of 183 patients (104 males, 79 females) underwent AC ± AUS by a single surgeon, with patients divided into three groups: spina bifida (n = 105), congenital anatomical anomalies (n = 22), and acquired bladder disorders (n = 56). The median follow-up was 17 years. Results: At 1 year 45 patients (24.6%) with an AC were continent and did not require an AUS. 27 (60%) performed clean intermittent self-catheterization (CISC) and 18 (40%) voided spontaneously. At long-term follow-up (LTFU), 36 (80%) of 45 patients were still dry. One hundred and thirty-eight patients (75.4%) had an AUS implanted for SWI. Twenty-seven AUS (20%) were explanted in the first year. At LTFU, 94 patients (68%) had the original AUS removed, with or without subsequent replacement-making this the most common complication. At LTFU, 71 (51.4%) of 138 patients were still dry with an AUS ± CISC. Overall, at LTFU, 157 (85.8%) of 183 patients were continent, 11 (6%) had an ileal conduit, and 15 (8.2%) were incontinent. Recurrent urinary tract infections occurred in 32% of patients, bladder stones in 12%, revision of the cystoplasty in 7%, and diversion in 10%. Renal function decreased at the expected physiological rate in patients with spina bifida, but more dramatically in other groups. Malignant transformation was detected in 4 patients (2.2%) at a median of 28.5 years post-AC. All tumors originated from the bladder segment. Conclusion: Overall, the long-term outcomes of AC alone are satisfactory. Outcomes in patients who had an AC and AUS were satisfactory on early to intermediate follow-up but were significantly less satisfactory in the longer term due to AUS-related complications.