This review begins with background information about the discovery and conceptual steps contributing to our current knowledge of purinergic signalling. It then deals with several topics concerned with the physiology and pathophysiology of the lower urinary tract, including: the involvement in the voiding reflex of
ATP released as a co-transmitter with
acetylcholine from parasympathetic nerves supplying the bladder and
ATP released from urothelial cells during bladder distension to initiate the voiding reflex via P2X₃ receptors on suburothelial low-threshold sensory nerve fibres; this latter mechanosensory transduction pathway is also involved via high-threshold fibres in the initiation of
pain. Treatment of prostate and
bladder cancer with
ATP not only appears to be effective against the primary tumours, but also improves the systemic symptoms associated with advanced
malignancy. There is dual control of the tone of blood vessels: constriction by
ATP released as a co-transmitter from sympathetic nerves and vasodilatation via
ATP released from endothelial cells during shear stress acting on endothelial P2 receptors to release
nitric oxide. A purinergic hypothesis is discussed for the mechanism underlying acupuncture, widely used for the treatment of urinary disorders.