To address the shortcomings of modern wastewater treatment, Ecological Sanitation (EcoSan) has been advocated as a sustainable approach to promote closed-loop flows of resources and nutrients from sanitation to agriculture. In this study, we discuss the rationale behind its conception and provide a state-of-the-art review on the subject. Through an exhaustive literature analysis of EcoSan systems, its historical developments and programs implemented worldwide we (i) validate the potential applicability and feasibility of decentralized, source-based sanitation and (ii) depict fundamental problems in EcoSan systems design that have stalled its adoption and proliferation. Specifically, we focus on urine diversion to demonstrate its potential to elegantly separate, collect and concentrate products that we require (nutrients) and those that we wish to regulate (pathogens and micropollutants). Since recent research efforts have been devoted to the technological recovery of nutrients from human urine, we believe that we are witnessing a paradigm shift within a paradigm shift as it represents a change in emphasis from ‘split-stream collection and reuse’ to ‘split-stream collection, resource recovery and safe reuse’. Our analysis of various nutrient recovery technologies for human urine indicates that provisioning of urine-diverting toilets tends to reduce sanitary risks; however, to contain and completely eliminate these risks continued research effort is needed to envision and implement integrated technological pathways that ensure simultaneous nutrient recovery, pathogen inactivation and reduction of pharmaceuticals and active substances. © 2016 Chinese Institute of Environmental Engineering, Taiwan