We carried out a systematic review and meta-analysis to assess the efficacy and safety of imidafenacin for treating overactive bladder in adult. A literature review was performed to identify all published randomized placebo-controlled trials of imidafenacin for the treatment of OAB. The search included the following databases: MEDLINE, EMBASE. The reference lists of retrieved studies were also investigated. Five publications involving a total of 1,428 patients were used in the analysis, which compared imidafenacin with propiverine and solifenacin. We found that imidafenacin was effective in treating OAB in our meta-analysis, which was similar to propiverine in its efficacy. The mean number of UI per week (the standardized mean difference (SMD) = 1.23, 95 % CI -0.19 to 2.65, p = 0.09), the mean number of urgency episodes per day (SMD = 0.26, 95 % CI -0.11 to 0.63, p = 0.17), the mean number of micturitions per day (SMD = 0.01, 95 % CI -0.30 to 0.31, p = 0.96), and the mean urine volume (ml) per micturition (SMD = -13.04, 95 % CI -20.45 to -5.62, p = 0.0006) indicated that imidafenacin was similar to propiverine in its efficacy. Mean OABSS (SMD = 0.48, 95 % CI -0.08 to 1.03, p = 0.09) indicated that imidafenacin was also similar to solifenacin in its efficacy. Besides, imidafenacin was better tolerated than propiverine in the safety, indicated by dry mouth (OR 0.73, 95 % CI 0.54-0.98, p = 0.04) and any adverse events (OR 0.63, 95 % CI 0.46-0.88, p = 0.006). Moreover, imidafenacin was also better tolerated than solifenacin in the safety, indicated by constipation (OR 0.21, 95 % CI 0.08-0.53, p = 0.001) and any adverse events (OR 0.33, 95 % CI 0.15-0.71, p = 0.004). This meta-analysis indicates that imidafenacin was similar to propiverine or solifenacin in its efficacy for OAB and was better tolerated than propiverine or solifenacin in the safety for OAB. We conclude that imidafenacin is preferable to propiverine or solifenacin from a perspective of safety.