The potential and scale of cities enable economic growth and the improvement of citizens’ access to jobs, education, healthcare, culture, public utilities and services. Solid waste management (SWM) is one of the key services provided by cities. Its operations are complex, very visible to the general public, and impacted by strong financial, societal, and political constraints. Performances in developing countries, however, are not positive. United Nations research shows urban collection services covering no more than 39% of the population in low-income countries. Why are many cities in developing countries not able to use their increasing wealth and scale for basic SWM services such as city cleaning, collection, and sustainable landfilling? This paper provides a review of literature on this question over the last decade. It shows that research is mostly on symptoms and has not led to a deeper diagnosis of causes. Lack of resources, infrastructure, awareness, and institutional strength are often pinpointed as causes but, in fact, they should be addressed as symptoms. These symptoms should be designated as dependent variables in a complex causal network with systemic feedbacks, hindering or neutralizing attempts to improve performances if not properly dealt with. Research should concentrate more on assessing the relations between urbanization, urban processes, and urban governance that shape the performance of urban solid waste management. System dynamics modeling may provide new approaches for this diagnosis.