Cities worldwide are challenged by a number of urban water issues associated with climate change, population growth and the associated water scarcity, wastewater flows and stormwater run-off. To address these problems decentralised solutions are increasingly being considered by water authorities, and integrated urban water management (IUWM) has emerged as a potential solution to most of these urban water challenges, and as the key to providing solutions incorporating decentralised concepts at a city wide scale. To incorporate decentralised options, there is a need to understand their performance and their impact on a city's total water cycle under alternative water and land management options. This includes changes to flow, nutrient and sediment regimes, energy use, greenhouse gas emissions, and the impacts on rivers, aquifers and estuaries. Application of the IUWM approach to large cities demands revisiting the fundamental role of water system design in sustainable city development. This paper uses the extended urban metabolism model (EUMM) to expand a logical definition for the aims of IUWM, and discusses the role of decentralised systems in IUWM and how IUWM principles can be incorporated into urban water planning.