Objective: To assess the degree of adherence to the current National Institute for Health and Clinical Excellence (NICE) guidelines on the management of urinary incontinence (UI) in women.

Design: Retrospective survey of consecutive female inpatients and outpatients with UI as part of a national audit.

Setting: NHS hospital and primary care (PC) trusts.

Population or Aample: 25 women younger than 65 years and 25 women aged 65 years or older from each participating site.

Method: All NHS trusts in England, Wales and Northern Ireland were eligible to participate.  A web-based data collection form aligned to the NICE guidelines was constructed for the study.  All data submitted to the audit were anonymous and access to the web-tool was password-protected for confidentiality.

Results: Data were returned by 128 acute and 75 PC trusts on 7846 women.  No diagnosis was documented in 6.8% (153/2254) of younger and 28% (571/2011) of older women in hospitals (P less than 0.001), and by 8.6% (123/1435) of younger and 21% (380/1786) of older women in PC trusts.  In hospitals, 26% (396/1524) of younger women and 15% (182/1231) of older women (P less than 0.001) and in PC trusts 8.2% (77/934) of younger and 4.7% (46/975) of older women underwent multichannel cystometry before conservative therapy.  Documentation of discussion of causes and treatment of UI occurred in 76% (1717/2254) of younger and 44% (884/2011) of older women in hospitals (P less than 0.001) and in 75% (1080/1435) of younger and 53% (948/1786) of older women in PC trusts (P less than 0.001).

Conclusions: Older women are less likely to receive NICE compliant management.  Adherence varies according to recommendation.  There needs to be concentration on evidence-based community provision of care by competent and interested clinicians before the aims of the NICE guidelines are met.