OBJECTIVE: Estimate direct medical costs of Urinary Incontinence (UI), namely Stress Urinary Incontinence (SUI), Mixed Urinary Incontinence (MUI) and Urge Urinary Incontinence (UUI) in Germany over 12 months. METHODS: PURE is an ongoing six-month, pan-European, prospective observational study to determine direct treatment costs for women with UI. Analysis includes 2175 German patients (mean age 65.1 years) with SUI (n=487), MUI (n=1457) or UUI (n=231) symptoms. Participating investigators are office based primary care physicians (n=110), urologists (n=185), gynaecologists (n=100) and other (n=4). Resource use data for cost estimation was collected retrospectively including medication, conservative treatment, diagnostic and surgical procedures, incontinence products and visits to health care providers for 12 months preceding baseline. Unit costs for 2004 from the perspective of statutory health insurance (SHI) were used. RESULTS: Average total annual costs for women with UI ranged from 413.0€ for SUI, 438.0€ for UUI to 585.2€ for MUI. Costs were primarily attributable to pad costs for SUI (223.5€), MUI (300.3€) and UUI (235.0€). A total of 52.4% of pad costs were incurred by SHI, with remaining costs being paid out-of-pocket. Average drug costs were 47.4€ for SUI, 86.1€ for MUI and 107.2€ for UUI. Patients receiving UI surgery had average surgical costs of 3326.9€. On average, 26.9% of patients with SUI, 44.0% with MUI and 52.8% with UUI were treated with UI medication, while 10.3% of patients with SUI, 16.8% with MUI and 17.5% with UUI were ever treated with surgery. Pad use ranged from 85%, 87.2% to 89.2% in SUI, MUI and UUI patients, respectively. CONCLUSION: Patients with MUI were found to incur the highest costs compared to patients with other UI subtypes. Patients with SUI were treated with UI medication not indicated for use in SUI. Incidence of previous UI surgery was considerable in this treatment seeking population.