Abstract This is the first part of a paper on urinary incontinence in the elderly man, dealing with epidemiology, pathophysiology and diagnostic work-up. Urge incontinence is the most frequent type of incontinence in elderly men. In about 50% terminal detrusor over activity is found: the urge to void comes up suddenly, without warning, accompanied by an uncontrolled detrusor contraction causing continence. A number of factors contribute to the development of urinary incontinence in the elderly, of which comorbidity is of uppermost importance. Incontinence in elderly men (and women) is not only a “bladder problem”. Patients with five or more diseases have a 100% risk of incontinence. This reflects the multifactorial pathogenesis in the ageing lower urinary tract influenced by medical, metabolic, neurogenic and orthopaedic disorders, hormonal alterations and obesity. Incontinence in the elderly is also a social-economic problem, the annual direct costs of urinary incontinence in the USA in 2001 were approximately USD 16.3 billions, 24% of them were required for men. Differentiating between stress, urge, mixed incontinence and continuous incontinence is paramount to selecting appropriate treatment for the individual patient. The basic diagnostic work comprises symptom assessment, physical examination, urine analysis and, most important, a bladder diary. Clearly, not all incontinent patients require sophisticated or even simple urodynamics, especially not the elderly with subsequent conservative therapy.