Purpose of Review <p>Overactive bladder (OAB) is a clinical diagnosis with a limited role for urodynamics (UDS), based on guidelines. Our purpose was to highlight clinical scenarios when UDS can add diagnostic value for patients who present with OAB symptoms, particularly to tailor individualized approaches.</p> Recent Findings <p>Recent literature supports the use of UDS in select OAB presentations. UDS can help in treatment planning and patient counseling in cases involving diagnostic uncertainty, coexisting bladder outlet obstruction or detrusor underactivity, dysfunctional voiding, and prior anti-incontinence surgery. In men with benign prostatic hyperplasia, UDS can help guide patient counseling prior to bladder outlet procedures. While some studies demonstrate limited outcome improvement with routine UDS, alignment of UDS findings with treatment may enhance long-term outcomes. Emerging non-invasive technologies offer promise as less invasive alternatives.</p> Summary <p>UDS should not be routinely used in the evaluation of OAB but can be beneficial in select patients where clinical uncertainty or pathophysiologic complexity exists. Given its limitations in predicting treatment response and added cost, UDS should be used judiciously and tailored to the needs of each patient. Future innovations may help broaden its utility while improving patient comfort and cost-effectiveness.</p>