Effective Integrated Water Management (IWM) is an aspiration for all those engaged in water service provision, and is a key component of the World Water Vision. Part of this includes the sustainability of water systems and their interaction with other urban systems. In the urban drainage field, there are many examples of attempts to establish effective integrated systems. A major problem, however, is the elusive nature of the concept of sustainability and how to translate what is known in terms of sustainability principles and objectives into action within the IWM perspective. Case studies are presented that illustrate how urban drainage problems can be approached in a way that takes due account of sustainability considerations. These studies utilise a new Guidebook that presents multi-criteria decision support systems to assist Water Service Providers (WSPs) to assess the relative sustainability of water/wastewater system asset development decisions. The Guidebook was developed as part of a UK government and industry funded multi-partner project over the past 4 years. An essential feature of the Guidebook is its transparency, as it is intended to be accessible to all stakeholders affected by a proposed development.