A placebo controlled, single-blind drug trial was designed to assess the efficacy of propantheline bromide (PB) in the treatment of urinary incontinence in geriatric institutionalized subjects with an uninhibited neurogenic bladder. Patients were randomly assigned to start PB 15 mg per 0s (PO) four times a day (QID), or placebo. Drug therapy was continued for 4 days after which a 3-day wash-out period was allowed before crossing over. Incontinence was recorded using an electronic monitor. If incontinence continued, the protocol was repeated at a 30-mg QID dose. Thirty-four patients completed the 15-mg protocol; no significant difference in continence was found between PB and placebo at this dose. Twenty-four patients completed the 30-mg dose, and a 17% improvement in continence was observed. This marginal clinical benefit was outweighed by the number of significant side effects. In conclusion, propantheline bromide was not a found to be a clinically useful agent for the rnanagment of incontinence in this group of institutionalized, elderly patients.