Pelvic floor ultrasound in prolapse: what's in it for the surgeon?

Pelvic reconstructive surgeons have suspected for over a century that childbirth-related trauma plays a major role in the aetiology of female pelvic organ prolapse. Modern imaging has recently allowed us to define and reliably diagnose some of this trauma. As a result, imaging is becoming increasingly important, since it allows us to identify patients at high risk of recurrence, and to define underlying problems rather than just surface anatomy. Ultrasound is the most appropriate form of imaging in urogynecology for reasons of cost, access and performance, and due to the fact that it provides information in real time. I will outline the main uses of this technology in pelvic reconstructive surgery and focus on areas in which the benefit to patients and clinicians is most evident. I will also try and give a perspective for the next 5 years, to consider how imaging may transform the way we deal with pelvic floor disorders.