OBJECTIVE: The Overactive Bladder Treatment Satisfaction Questionnaire (OAB-S) is a self-administered instrument assessing treatment satisfaction in patients with overactive bladder. The OAB-S has been developed for worldwide use; moreover, its conceptual equivalence and cultural adaptability across countries were considered early in the development process. To date, the OAB-S is available in five languages including US-English, US-Spanish, UK-English, Spain-Spanish and German. METHODS: The cultural and linguistic equivalence of the OAB-S was ensured at different stages of the development and the translation processes: 1) the OAB-S was simultaneously developed in US-English and US-Spanish and tested for face and content validity; 2) the pre-final original questionnaire underwent a translatability assessment, an international critical review with the objective of suggesting re-formulations in the pre-final version considering the context and constraints of other languages and cultures; 3) finally, the OAB-S was translated into the three remaining languages according to an internationally accepted methodology: two forward translations, one backward translation by independent native speakers, review by one clinician per country and cognitive debriefing on five patients in each language. RESULTS: A common list of concepts in US-English and US-Spanish were developed following patients' interviews, and were later used to generate the pre-final instrument. The translatability assessment allowed refinement of concepts (i.e., “focus on work” or “interference of OAB symptoms”), idiomatic expressions (i.e., pad, urgency to urinate) and responses scales. Once the final questionnaire was translated, patient interviews demonstrated a high level of understanding and an absence of any problematic wording. CONCLUSION: Since the conceptual equivalence of the OAB-S across cultures and languages was considered early in the development process, translation issues were reduced to a minimum. The OAB-S is a comprehensive measure that will enable documentation of patients' satisfaction with treatment in international trials using these languages.