Background: The aim of this study was to provide a potential surgical efficacy assessment in the treatment of pelvic organ prolapse (POP)., Methods: A retrospective cohort study was performed on magnetic resonance imaging (MRI) imaging data of 16 non-prolapsed (control group) and 30 preoperative and postoperative POP (case group) women from 2019 to 2021 at the First Affiliated Hospital of Kunming Medical University. MRI diagnoses and measures of the relevant anatomical points at rest were used to analyze the healthy control data and the data from POP women before and after surgery., Results: The middle vaginal-PICS line angle (78.12°±15.03° vs. 69.35°±11.51°, 78.12°±15.03° vs. 61.56°±9.58°, P<0.05) and the middle-lower vaginal angle (179.30°±12.96° vs. 161.73°±10.42°, 179.30°±12.96° vs. 147.01°±12.20°, P<0.05) in the preoperative group were significantly larger than those in the control and postoperative groups. Y-axis coordinates of the endocervical orifice (-52.39±15.63 vs. -59.04±11.49 mm, -52.39±15.63 vs. -65.27±7.25 mm, P<0.05), posterior vaginal fornix (-34.25±13.30 vs. -46.69±11.09 mm, -34.25±13.30 vs. -49.93±8.02 mm, P<0.05), the junction of the middle and lower vagina (-0.48±8.65 vs. -11.34±7.33 mm, -0.48±8.65 vs. -10.11±9.77 mm, P<0.05), and anterior vaginal fornix (-23.14±13.71 vs. -34.68±9.07 mm, -23.14±13.71 vs. -38.64±6.48 mm, P<0.05), as well as the x-axes of the junction of the middle and lower parts of the vagina (26.79±6.71 vs. 19.56±5.24, 26.79±6.71 vs. 17.67±5.81, P<0.05), and vaginal introitus (23.39±7.12 vs. 18.55±4.22, 23.39±7.12 vs. 19.00±4.55, P<0.05) in the preoperative group were smaller than those of the control and postoperative groups. Differences between the control and postoperative groups were not statistically significant (P>0.05)., Conclusions: The current study established that the uterine-vaginal axis of POP women moved backward and downward in the coordinate system, as shown on MRI sagittal images. Further, it moved forward and upwards after surgical repair and more closely resembled that of the control group. The uterine-vaginal axis may provide an evaluation of surgical efficacy in women with POP., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-1173/coif). The authors have no conflicts of interest to declare., (2022 Annals of Translational Medicine. All rights reserved.)