Angiogenesis is a key process in the growth and metastasis of cancer, and genitourinary tumors are no exception. The evolution of angiogenesis as an important target for novel anticancer therapeutics has brought with it new challenges for in vivo imaging. Most imaging techniques quantify physiological parameters, such as blood volume and capillary endothelial permeability. Although CT, PET and ultrasonography have shown promise, MRI is the most common method used to evaluate angiogenesis in clinical trials of genitourinary tumors. Pilot studies of MRI, CT and ultrasonography in patients with renal cancer have produced promising results; reductions in vascular permeability and blood flow have been correlated with progression-free survival. The vascular characteristics of prostate cancer have been evaluated by MRI, and this has been suggested as a means of assessing tumor response to hormone deprivation therapy. Current evidence highlights the potential of angiogenesis imaging in the diagnosis, staging and possibly response monitoring of bladder cancer. In the future, assessment of the angiogenic process at the structural, functional and molecular levels, before, during and after antiangiogenic therapy will undoubtedly be integrated into wider clinical practice.