The refractory overactive bladder is a clinically challenging entity to manage and affects millions of people worldwide. Current surgical treatment options include botulinum toxin type A, sacral neuromodulation, and bladder reconstruction surgery all of which require careful attention to the individual patients needs and circumstances. In our paper we present a detailed up-to-date review on all the above mentioned surgical techniques from current literature and briefly describe our units experience with sacral neuromodulation.