A proposed scoring system for the management of female urinary incontinence. 
The management of urinary incontinence is frequently ineffective.  Inappropriate surgical intervention can convert medically treatable incontinence into a more serious and less remediable condition.  To allow a more scientific approach to management, we have developed a scoring system for female incontinence based on three primary controlling factors: (1) the direction of the urethra, (2) the urethral vesical angle and (3) the urethral pressure profile.  For each factor a score of 1 to 3 was assigned according to the deviation from normal anatomy or function.  Scores ranged from 3 to 9.  Patients scoring 6 to 9 were treated surgically, by ventral suspension of the bladder neck and urethra.  Patients scoring 3 to 5 were treated medically and underwent surgery only if indicated for other pathology.  Thirty-three patients were evaluated and treated with this approach, with a one- to two-year follow-up.  This system appears to provide an objective method of choosing between surgical and medical therapy for urinary incontinence.