Extreme rainfall variability, record droughts, floods and high temperatures have had a major impact on social wellbeing, economic productivity and environmental functionality of urban settings in Australia. Compounded by urban growth and ageing water and wastewater infrastructure, Australia's urban water arrangements have undergone major reforms to effectively manage the challenges of recent years. This paper is a synthesis of urban water reform in Australia during a decade of unforeseen natural extremes. It summarises the evolution of urban water policy, outcomes from recent government reforms and investment, and presents future challenges facing the sector. As governments at state and federal levels in Australia have moved to diversify supply options away from the traditional reliance on rainfall-dependent catchment storages, they have been confronted by issues relating to climate uncertainty, planning, regulation, pricing, institutional reforms, and community demands for sustainable supply solutions. Increases in water prices to pay for new water infrastructure are illustrative of further reform pressures in the urban water sector. In the past 10 years the Australian urban water sector has weathered new extremes in drought and flood and emerged far different to its predecessor. The provision of safe, secure, efficient and sustainable water and wastewater services remains the primary driver for urban water reform. However the challenges and opportunities to improve nationally significant social, economic and environmental outcomes from urban water have evolved considerably. The focus now is on creating the institutional, regulatory and market conditions favourable for the integration of urban water services with the objectives for productive and liveable cities.