There is an overall trend towards development of once daily extended release preparations for existing anticholinergics, such as extended release oxybutynin and propiverine. Multiple strengths are now available in certain once daily agents such as solifenacin, allowing more flexible therapeutic options. Urinary urgency does not always arise within the bladder, and that when investigating OAB we should consider a variety of pathological causes. With the exception of botulinum toxin and neuromodulation for failed medical therapy for OAB, there have been no new important surgical innovations. These last two options have superceded bladder augmentation by bowel interposition, since they are far less invasive, are reversible, and have fewer side effects.