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Melanosis of the bladder is characterized by dark, velvety bladder mucosa due to melanin deposition. Less than 25 cases have been reported. We present a 45-year-old male undergoing work up for obstructive and storage irritative lower urinary tract symptoms, found to have diffuse bladder melanosis on cystoscopy with bladder biopsy, and detrusor overactivity on urodynamic study. Although bladder melanosis has been found before in conjunction with storage voiding symptoms, this is the first report to our knowledge of an association with overactive bladder with urodynamic and histologic confirmation.