OBJECTIVES: To carry out a systematic review and meta-analysis of solifenacin succinate and trospium chloride, two widely used anticholinergic drugs in the treatment of overactive bladder, in order to provide evidence on which formulary and prescribing decisions can be based upon. METHODS: Electronic searches of PubMed, the Cochrane Library, other electronic search engines, as well as manual searches of relevant papers, for randomised controlled trials comparing solifenacin succinate and trospium chloride with one another, with other anticholinergic drugs, or with placebo, from 2003 to October 2011 yielded 260 titles and abstracts from which 8 papers were included in the meta-analysis. Five were trials comparing solifenacin 5mg and 10mg with placebo, while 3 were trials of trospium chloride 20mg (twice a day) immediate release (IR) or 60mg extended release (ER) versus placebo.  No direct head to head clinical trials comparing trospium and solifenacin with each other were found. Hence the method of adjusted indirect comparison was used to compare them. RESULTS: There was greater improvement from baseline with both solifenacin 5mg and solifenacin 10mg compared to trospium ER in daily micturitions:  mean differences (md) (95% CI) -0.89 (-1.14, -0.70) and -1.25 (-1.66, -0.95) respectively, and -0.93 (-1.39, -0.62), and -1.31 (-2.00, -0.85) when compared to trospium IR. Similarly for urinary urgency incontinence: md (95% CI) were -0.78 (-1.43, -0.42) in favour of solifenacin 5mg compared to trospium ER,  -0.75 (-1.46, -0.38) in favour of solifenacin 10mg versus trospium ER and -1.55 (-2.17, -1.11) and -1.5 (-2.30, -0.98) comparing solifenacin 5mg and 10mg to trospium IR. There were no statistically significant differences in discontinuations due to adverse events including both dry mouth and constipation. CONCLUSIONS: Solifenacin appears to be more efficacious than trospium (IR and ER) in ameliorating the symptoms associated with overactive bladder syndrome but shows no statistically significant differences in common safety and tolerability issues.