The urogenital system is responsible for the formation, storage and elimination of urine and for reproductive activity. Many functions of the urogenital system are controlled by autonomic (parasympathetic and sympathetic) and somatic efferent pathways originating in the lumbosacral spinal cord. These pathways regulate the activity of smooth muscle, striated muscle, epithelial cells, and exocrine glands in the urogenital organs via the release of multiple neurotransmitters, including acetylcholine (ACh), norepinephrine, adenosine triphosphate and nitric oxide. This article reviews the innervation of the urogenital organs, the functions controlled by the different neural pathways and the physiology and pharmacology of neurotransmission.