Overactive bladder is a common symptom complex with health related quality of life impacts on the individual as well as utilizing health resources. Antimuscarinic therapy has been the mainstay of treatment and is well supported within the literature and guidelines. However, compliance is poor due to lack of efficacy and adverse events leading to the development of novel therapies. Mirabegron, the B3-adrenoreceptor agonist has emerged as an evidence-based alternative first or second line therapy. Two decades after its first clinical application for overactive bladder, intravesical botulinum toxin is now an important part of any clinician's armamentarium for refractory cases. Despite these therapeutic options many patients find therapies ineffective or have adverse events. This has resulted in ongoing developments in the understanding of overactive bladder, potential new drugs and combination therapies, which this paper intends to review.