Objective The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence (UI) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a randomized trial comparing these procedures. Study Design Resources used for UI management (supplies, laundry, dry cleaning) were self-reported by 491 women at baseline and 24 months after surgery, and total out-of-pocket costs for UI management (in 2012 US dollars) were estimated. Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months. Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test. Predictors of change in cost were examined using multivariate mixed models. Results At baseline mean (±SD) age of participants was 53 10 years, and the frequency of weekly UI episodes was 23 21. Weekly UI episodes decreased by 86% at 24 months (P <.001). The mean weekly cost was $16.60 $27.00 (median $9.39) at baseline and $4.57 $15.00 (median $0.10) at 24 months (P <.001), a decrease of 72%. In multivariate analyses, cost decreased by $3.38 $0.77 per week for each decrease of 1 UI episode per day (P <.001) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores (P <.001) and decreased 24-hour pad weight (P <.02). Conclusion Following Burch or fascial sling surgery, the UI management cost at 24 months decreased by 72% ($625 per woman per year) and was strongly associated with decreasing UI frequency. Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures. © 2014 Mosby, Inc. All rights reserved.