Mass balances are an instructive means for investigating the fate of chemicals during wastewater treatment. In addition to the aqueous-phase removal efficiency (phi), they can inform on chemical partitioning, transformation, and persistence, as well as on the chemical loading to streams and soils receiving, respectively, treated effluent and digested sewage sludge (biosolids). Release rates computed on a per-capita basis can serve to extrapolate findings to a larger scale. This review examines over a dozen mass balances conducted for various organic wastewater contaminants, including prescription drugs, estrogens, fragrances, antimicrobials, and surfactants of differing sorption potential (hydrophobicity), here expressed as the 1-octanol-water partition coefficient (K(OW)) and the organic carbon normalized sorption coefficient (K(OC)). Major challengesto mass balances are the collection of representative samples and accurate quantification of chemicals in sludge. A meta-analysis of peer-reviewed data identified sorption potential as the principal determinant governing chemical persistence in biosolids. Occurrence data for organic wastewater compounds detected in digested sludge followed a simple nonlinear model that required only K(OW) or K(OC) as the input and yielded a correlation coefficient of 0.9 in both instances. The model predicted persistence in biosolids for the majority (> 50%) of the input load of organic wastewater compounds featuring a log10 K(OW) value of greater than 5.2 (log10 K(OC) > 4.4). In contrast, hydrophobicity had no or only limited value for estimating, respectively, phi and the overall persistence of a chemical during conventional wastewater treatment.