OBJECTIVES: To estimate the direct annual costs (from May 2004 to May 2005) associated with Lower Urinary Tract Symptoms (LUTS) in Italian women from the NHS perspective. To assess, at the same time, costs borne by subgroup of women with Urinary Incontinence (UI). METHODS: This evaluation was carried out as a part of the FLOW project: a 2-year observational study aimed at evaluating the prevalence, incidence and remission rates of LUTS in a large sample of women followed at 39 Italian Urology Clinics. NHS costs, such as specialist visits, hospitalizations, therapy and laboratory tests were collected retrospectively. The Dowell-Bryant Incontinence Cost Index (DBICI) was used to investigate personal UI costs, such as: disposable pads, re-usable incontinence products, laundry and health professional expenditure, surgery/diagnostic investigation and medication. RESULTS: A sample of 279 women were re-evaluated after two years follow-up. The estimated total annual cost to the Italian NHS for curing female with LUTS ranged between €704,888,43 and €1,325,850,296. The average annual NHS costs per patient in our sample were €232.90, of which the major components were: rehabilitative therapy (€83.24), surgical therapy (€64.54) and instrumental tests (€47.39). As for women with UI, surgery interventions accounted for 35% of the total NHS costs Vs 27% for whole study sample with LUTS. Regarding women with UI, the average annual personal cost estimated by DBICI was 215.21€ of which disposable pads and medications accounted respectively for 50% and 33%. CONCLUSION: After 2-yr follow-up the higher costs for the NHS seem to be associated to rehabilitative therapy and surgical procedures. Some differences were detected among the NHS resources used by the subgroup of women with UI. Costs borne by women with UI were quite high and the most important estimated component were the use of disposable products.