Overactive bladder syndrome is a common and highly bothersome problem in the general adult population and a major source of health expenditure in industrialized nations. Much research has been undertaken to advance the understanding of the symptom syndrome and develop optimal management strategies. Although, currently, treatment options are increasing, it is often the case that treatment is inefficacious, impractical or associated with intolerable side effects. The latest European Association of Urology guidelines provides evidence-based recommendations for the diagnosis and management of overactive bladder syndrome within the guidelines for urinary incontinence in women and men as well as non-neurogenic male lower urinary tract symptoms. Their aim is to improve the standard of care of patients with lower urinary tract symptoms. In this article we review the latest guidance and discuss the evidence behind the recommendations, and the practical aspects of their application, as well as their limitations.