Midurethral synthetic slings (MUS) have become the standard of care in the management of stress urinary incontinence. However, they can be associated with the development of de novo overactive bladder symptoms, a leading cause of poor patient satisfaction after sling surgery. The purpose of this review is to focus on the incidence, risk factors, and management of de novo overactive bladder (OAB) symptoms after sling placement. Recent studies have determined risk factors in the identification of patients at the highest risk to develop de novo OAB. Bladder outlet obstruction, urinary tract infections, and foreign bodies need be ruled out prior to the management of de novo OAB. Recent data has focused on specific therapies that may improve de novo OAB results, including onabotulinumtoxinA and oral medications. De novo OAB is a common post-operative complication that may be organic or idiopathic. Further research needs to focus on the etiology and management of this common MUS complication.