Introduction <p>A systematic review with meta-analysis was carried out to study the hypothesis that bladder wall thickness measured by ultrasound is accurate at diagnosing detrusor overactivity in women.</p> Method <p>This meta-analysis was registered on PROSPERO. A literature search was conducted using online databases Embase, Medline, and PubMed. Quality of articles was assessed, and articles were divided into groups to reduce heterogeneity for meta-analysis.</p> Results <p>A total of eight studies were selected for analysis. The mean bladder wall thickness in those “with detrusor overactivity” was found to be 5.234+/−1.424 and those “without detrusor overactivity” 4.356+/−1.124. Those “with detrusor overactivity” were found to have a mean increased bladder wall thickness of 0.879+/−0.958 (95% CI 0.143 to 1.615) when compared to those “without detrusor overactivity”. Meta-analysis was performed with six of the eight studies to reduce heterogeneity of data. We found no overall effect and no significant difference in measurements taken in those “with detrusor overactivity” and those “without detrusor overactivity”. Tests of heterogeneity demonstrate a moderate level of heterogeneity I² = 61.4% and T² = 0.049. A summary receiver operator characteristic curve was used to demonstrate overall performance of ultrasound measurement of bladder wall thickness as an alternative diagnostic test of urodynamic detrusor overactivity.</p> Conclusions <p>Meta-analysis has demonstrated that measurement of bladder wall thickness using ultrasound cannot be used to diagnose detrusor overactivity and can therefore not replace urodynamics in the investigation of women with lower urinary tract symptoms. The results of this meta-analysis must be viewed with the understanding that studies included showed significant heterogeneity despite efforts to reduce large variation in data.</p>