Anaerobic ammonium-oxidizing (anammox) bacteria convert ammonium to N-2 with nitrite as the terminal electron acceptor in the absence of O-2. Nitritation-anammox bioreactors provide a cost-effective and environment-friendly alternative to conventional nitrification/denitrification nitrogen removal systems. Currently, this process is only applied for ammonium removal from wastewater with high ammonium load and temperature. Nevertheless, recent results obtained with laboratory-scale bioreactors suggest new possible routes of application of the Nitritation-anammox technology including (1) municipal wastewater treatment, removal of (2) methane in combination with nitrite-reducing methane-oxidizing bacteria, (3) nitrate coupled to organic acid oxidation and (4) nitrogen oxides. The current review summarizes the state-of-the-art of the application of Nitritation-anammox systems and discusses the possibilities of utilizing these recent results for wastewater treatment.