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Objective To evaluate prospectively the short-and long-term results of treatment with vaginal cones for women with urinary stress incontinence and to assess predictive parameters. Patients and methods Fifty women (mean age 49 years, range 28-76) with differing severities of stress incontinence (mean parity 2.4 and mean 60-min pad-test 20.7 g) were treated with cones for 15 min twice a day for 8 weeks. Treatment results were evaluated immediately after and at a mean of 3 years after the treatment. Parameters were analysed to determine those with predictive value for a successful outcome. Results Physiotherapy was assessed as being successful, i.e. a complete cure or a reduction of > 50% of the original severity, in seven patients (14%), while in 43 patients (86%) the treatment failed. After 3 years, 13 (30%) reported that the treatment was successful, 27 (61%) reported failure and four (9%) underwent surgery for stress incontinence. Those with lesser amounts of urinary loss and those with less frequent incontinence would be most likely to benefit from treatment with vaginal cones. Conclusion The treatment had a low success rate and we recommend that the vaginal cones should be used only for those with a slight or moderate degree of stress incontinence. [ABSTRACT FROM AUTHOR]