The evolution of urological imaging has had a major impact on the diagnosis and treatment of urological diseases since the discovery of the X-ray by Roentgen in 1895. Early developments included plain films of the abdomen, retrograde urographic techniques, development of contrast media, excretory urography, renal mass puncture, renal angiography, cystography and nuclear medicine procedures. These procedures led to the maturation of the specialties of diagnostic radiology and urology, and the development of the subspecialties of pediatric urology and urological radiology during the first seven decades of the 20th century. Subsequently, many imaging advances have occurred leading to changes in diagnosis and management of urological patients. Ultrasound and cross-sectional imaging technologies (computed tomography and magnetic resonance imaging) are increasingly applied in urological evaluation, treatment and surveillance. Current developments include dual energy computed tomography, positron emission tomography computed tomography, renal donor and renal transplant imaging, prostate magnetic resonance imaging, and microbubble contrast enhanced ultrasound. Imaging advances will continue. It is the responsibility of all physicians to assess the advantages of new developments while weighing those advantages against the additional radiation exposure and the costs associated with new procedures. © 2010 The Japanese Urological Association.