SUMMARY One thousand and sixty women aged 18 or over, randomly selected from a defined geographical area in South Wales, were interviewed at home about their urinary symptoms. Ninety-five per cent co-operated, of whom 45% admitted to some degree of incontinence. 'Stress' incontinence was reported by 22% of women, 'urge' incontinence by 10%, and both types combined-'complex'-by 14%. In most women urinary loss was both small and infrequent but 5% of all women experienced a loss sufficient to necessitate a change of clothes; in 2-6% such loss occurred daily. Over 3% of all women reported that incontinence interfered with their social or domestic life but only half of these had sought medical advice.Urinary incontinence is a troublesome and probably underreported1 disorder in women. Its prevalence in the general community is unknown. The purpose of the present report is to measure the prevalence and severity of incontinence, and to estimate its social consequences among women from a South Wales community. MethodA random sample of 1140 women was drawn from the electoral register for a defined geographical area in South Wales centred on a light industrial town (population 38 000). Each of the selected women was sent a letter explaining the study and then visited by one of five female interviewers who had been trained by the first author in interviews in a cervical cytology clinic. A standard questionnaire,* which had been developed for an earlier survey,2 was used throughout. In order to minimise embarrassment, questions were asked first on general medical history and then on urinary symptoms and incontinence.These latter questions referred to a period of 12 'Copies of the appropriate sections of the questionnaire can be obtained from the authors. months before each interview and unless otherwise stated the results refer to the prevalence of incontinence during a period of 12 months.A symptomatic classification of the type of incontinence was derived from a section of the questionnaire. This is similar to that used in a study in

169 female patients with outlet obstruction have been studied urodynamically. The results of treatment of the outlet obstruction in 102 patients have been analysed and the reason for the failures discussed. Patients with stable detrusors and those with symptoms of recurrent urinary tract infection responded well to treatment, provided this relieved the obstruction adequately; symptomatic relief was less common in patients with unstable detrusors, despite adequate outflow readjustment.

Forty patients with refractory urge incontinence were treated by "clam" ileocystoplasty. Thirty patients were cured of their symptoms and are voiding spontaneously, six were cured of their symptoms and are on clean intermittent self-catheterisation and four had their symptoms significantly improved by the operation. Bladder compliance is usually improved by the operation and detrusor instability is either abolished or reduced to an insignificant level, but voiding dysfunction is a common post-operative problem and must be identified and treated.

The results of a double-blind controlled trial using oxybutynin chloride in 30 patients are described. Twenty-three patients completed the study; 17 of these had symptomatic improvement and 9 patients had urodynamic improvement. Seventeen patients had significant side effects.