BACKGROUND: Overactive bladder (OAB) is a prevalent condition that substantially impairs quality of life (QoL); however, the real-world utility of standard behavioral and pharmacological therapies is often limited by poor long-term adherence. Digital interventions have emerged as a promising strategy to provide accessible and personalized support, but their overall efficacy compared with conventional care remains to be systematically established. OBJECTIVE: This study aimed to evaluate the efficacy of digital interventions compared with conventional care for improving symptoms, QoL, and treatment adherence in patients with OAB. METHODS: We conducted a systematic review and meta-analysis using data from PubMed, Embase, the Cochrane Library, and other databases from inception to July 2025. Randomized controlled trials (RCTs) assessing technology-based digital interventions for adult patients with OAB were included. The primary outcomes were objective symptom improvement (measured by bladder diaries) and subjective symptom scores, while secondary outcomes included QoL and attrition rates. Data were pooled using a random-effects model, and subgroup analyses were performed according to the delivery and supervision category (automated or app-based therapeutic content, telemedicine-supported care management, or digitally supervised behavioral or rehabilitation support) and intervention duration. RESULTS: Seven RCTs involving 544 participants were included. Digital interventions were associated with a significant improvement in overall objective symptom indicators compared with conventional care (mean difference [MD] -1.72, 95% CI -2.61 to -0.83; P<.001), specifically reducing 24-hour urinary frequency (MD -2.55, 95% CI -4.22 to -0.89; P=.003) and urge incontinence episodes (MD -2.07, 95% CI -2.72 to -1.42; P<.001). The pooled analysis of subjective symptom scores did not reach statistical significance (standardized MD [SMD] -1.07, 95% CI -2.18 to 0.05; P=.06). Exploratory subgroup analysis suggested that digitally supervised behavioral or rehabilitation support had the largest point estimate (SMD -2.51, 95% CI -5.03 to 0.01), although the CI crossed the line of no effect, and the finding was based on 2 heterogeneous studies. The prespecified subgroup analysis by intervention duration showed that interventions lasting 6 to 13 weeks were associated with symptom reduction (SMD -1.41, 95% CI -2.70 to -0.11; P=.03), suggesting a potentially favorable duration range. Furthermore, digital interventions significantly improved QoL (SMD 1.47, 95% CI 0.11-2.84; P=.03). No significant difference was observed in dropout rates between digital and conventional care groups (risk ratio 0.92, 95% CI 0.59 to 1.45; P=.72). CONCLUSIONS: Digital interventions may improve objective symptoms and QoL in patients with OAB, with comparable short-term attrition to conventional care. Interventions with higher-intensity digital supervision may have potential for symptom reduction, but this finding remains uncertain because of the small number of heterogeneous studies. These findings may inform future stepped care models, but further well-designed, longer-term RCTs are needed to confirm optimal implementation strategies. TRIAL REGISTRATION: PROSPERO CRD420251164488; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251164488.