Our objective was to assess the benefit of additional pelvic floor exercises, supervised by specialist physiotherapists, in the secondary care management of urinary stress incontinence. This is a retrospective cohort study in a UK University teaching hospital. A total of 317 women were referred from primary care to a specialist continence clinic for management of urinary stress incontinence. The cases were identified from the clinic database and a case note review performed. Data were collected on initial clinical assessment, suitability for pelvic floor exercises and outcome of treatment. The main outcome measures were adherence to primary care guidelines, suitability for further pelvic floor exercises and outcome of exercises. In total, 201 women were deemed suitable for a trial of further pelvic floor exercises, of whom 82 had previously attempted this in the primary care setting. After completing a course of physiotherapist supervised exercises, 105 women were able to be discharged from secondary care as a result of their symptoms improving. Of these women, 46 had previously attempted pelvic floor exercises in the community. It was seen that the primary care guidelines are poorly adhered to and where pelvic floor exercises are attempted in the community, the outcomes appear to be suboptimal. In appropriately selected women, a trial of additional physiotherapist-supervised exercises is beneficial and can reduce the urodynamic and surgical workload by 33%.