Abstract: Urinary system diseases are complex disorders caused by the combined effects of genetic, epigenetic, and environmental factors. The urinary system is highly susceptible to environmental hazards due to its unique physiological characteristics, such as the concentration of harmful substances through blood filtration in the kidneys and the continuous exposure of the bladder to urine containing metabolites of environmental pollutants. These environmental hazards disrupt the homeostasis of the tissue microenvironment in the urinary system, affect functional cells, and remodel intercellular communication networks, thereby contributing to the occurrence and development of urinary system diseases. Extracellular vesicles (EVs) serve as novel intercellular communication vehicles that transport bioactive cargo such as proteins and nucleic acids with biomarker potential, participating in both physiological and pathological processes of the urinary system via signal transduction mechanisms. This study systematically summarizes the bridging role of EVs between environmental hazards and urinary system diseases, explores their mechanisms, and anticipates their clinical application potential as biomarkers and drug vehicles.