OBJECTIVES: Treatment persistence to pharmacological OAB treatment is known to be low and may vary by type of antimuscarinic used. The aim of this study was to estimate treatment persistence associated with fesoterodine, solifenacin or tolterodine in routine clinical practice in Spain. METHODS: A retrospective study was conducted using Primary Care electronic medical records from three towns in Spain. Records from patients who newly initiated OAB treatment between January 2008 and December 2010, with at least 52 weeks of follow-up, were retained. Male and female patients, over 18, with a diagnosis of OAB [ICD-9-CM 596.51], and a new prescription of fesoterodine, tolterodine or solifenacin were included in this analysis.  Pattern of treatment persistence was assessed using a Cox-proportional hazard regression model and binary logistic regression adjusting for study location, age, sex, medication possession ratio, co-morbidity burden and time since diagnosis.   RESULTS: A total of 1971 records (58.3% women, mean age 70.1 [SD:10.6]) were analyzed; 302 treated with fesoterodine, 952 with solifenacin and 717 with tolterodine. Unadjusted mean treatment duration was 31.5 (17.6) weeks for fesoterodine, 29.9 (21.4) for solifenacin, and 29.0 (21.6) for tolterodine, p=0.217. Cumulative adjusted likelihood of discontinuation at 52 weeks was on average 22% higher for solifenacin [Hazard Ratio= 1.22 (1.03;1.44); p=0.020] and 25% higher for tolterodine [HR= 1.25 (1.05;1.49); p=0.014] than fesoterodine. At week 52, 37.1% of fesoterodine-treated patients remained on initial therapy versus 33.1% solifenacin-treated [adjusted OR=0.77 (0.58;1.03), p=0.078] and 32.1% tolterodine-treated [adjusted OR=0.75 (0.55;1.03),p=0.075] patients. CONCLUSIONS: Cumulative likelihood of discontinuating new antimuscarinic treatment for OAB over a 52-week was significantly higher for solifenacin or tolterodine compared to fesoterodine in Spanish clinical practice, yielding to a trend toward higher persistent rates at 52 weeks for fesoterodine.