A detailed working knowledge of normal and abnormal female pelvic anatomy is necessary for the proper evaluation of pelvic organ prolapse. However, even the most experienced gynecologist or urologist may have difficulty distinguishing among prolapsing organs competing for introital space. Accurate identification of all aspects of vaginal prolapse and pelvic floor relaxation are vital, not only to permit adequate surgical planning, but also to reduce the risk of recurrent prolapse. Radiographic evaluation of the woman with pelvic organ prolapse and pelvic floor relaxation should be viewed as a valuable extension of the physical examination. Urography, voiding cystogra-phy, dynamic colpocystodefecography, and MRI are each useful for the evaluation of pelvic prolapse and pelvic floor relaxation. Magnetic resonance imaging will continue to have an increasingly important role, because of its superior visualization of fluid-filled viscera and soft tissues, and the ability to simultaneously visualize all important pelvic organs without the need for patient preparation or instrumentation, or exposure to ionizing radiation.

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