Purpose of Review <p>Surgical management of overactive bladder (OAB) was traditionally considered third line therapy, but the treatment algorithm has shifted to favor shared-decision making. The purpose of this review is to discuss recent advancements in surgical and procedural interventions for OAB that may now be considered a primary therapy or part of a multimodal approach.</p> Recent Findings <p>Intravesical injection of OnabotulinumtoxinA (BTXA), Sacral neuromodulation (SNM), and Percutaneous or Transcutaneous Nerve Stimulation (PTNS and TTNS) are safe and effective treatment options for the management of OAB. Recent studies highlight modifications of BTXA injection technique, with some studies showing that BTXA can be safely and effectively administered with inclusion of the trigone and fewer injections. There is also evidence that prophylactic antibiotics and post-void residual checks after BTXA may be eliminated without increasing adverse events. Advancements in SNM include a single phase approach, smaller and rechargeable devices with less need for battery replacement. Peripheral nerve stimulation now includes options for implantable devices with similar efficacy to SNM. Radiofrequency ablation is a newer treatment modality that has shown some success in improving OAB symptoms. Finally, side effects associated with end stage bladder augmentation and urinary diversion can safely be managed with the use of BTXA injections.</p> Summary <p>Based on the published literature, we recommend optimizing the surgical management of OAB to maximize adherence and minimize complications.</p>