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A survey conducted in Italy revealed that less than 0.5% out of a sample of over 2,000 municipal wastewater treatment plants is equipped with an enhanced biological phosphorus removal process. Conditions promoting biological phosphorus removal have been investigated by monitoring three real plants equipped with, respectively: (A) simultaneous chemical precipitation; (B) enhanced biological removal powered by chemical precipitation; (C) tertiary chemical precipitation with evidence of phosphate accumulating bacteria. An anaerobic compartment revealed essential for the growth of these microorganisms, the readily degradable organic concentration in the influent playing a minor role. Mapping dissolved oxygen and oxidation-reduction potential in different compartments of plant (C) was carried out to understand the reasons why phosphate accumulating bacteria were found even in the absence of anaerobic reactor. Finally, the possibility to exploit the biological phosphorus removal in plant (C), by adjusting the aeration conditions, was explored and an economic analysis showed this to be a preferable approach with respect to the chemical removal of phosphorus. • The first Italian survey concerning EBPR application to urban WWTPs is presented. • Extensive and multi-level monitoring of three full-scale WWTPs was performed. • Factors promoting the presence of Polyphosphate Accumulating Bacteria were identified. • Economic evaluation of different alternatives for phosphorus removal was performed. • Experimental outcomes could provide valuable information for practical applications. [ABSTRACT FROM AUTHOR]