Terra Preta Sanitation (TPS) plays a key role in sustainable sanitation (SuSan) and in the sustainable management of resources such as water, energy, soil (agriculture), liquid and solid organic waste streams as well as in the development of sustainable urban environment and infrastructure systems. This paper discusses the advantages of, and requirements for, SuSan systems, focusing on TPS. Case studies showing the stepwise extension and re-development of conventional sanitation systems (CSS) using TPS technologies and system approaches are presented and discussed. Decentralized TPS systems integrated in sustainable urban resource management were implemented in the German cities of Hamburg and Berlin. The compilation of best practice examples and findings using the newest TPS systems illustrates the immense potential of this approach for the transformation from conventional to SuSan systems. For this purpose, the potential savings of drinking water resources and the recycling potential of nutrient components are quantified. The results strongly suggest the need to encourage the development and application of innovative decentralized sanitation technologies, urban infrastructures, and resource management systems that have TP as a key component.