Retropubic urethropexy procedures generally include the Burch colposuspension, the Marshall-Marchetti-Krantz (MMK), and the paravaginal defect repair. The latter two are really only of historical significance. It is important to understand potential complications of these procedures, principles of prevention, and their management strategies. Complications of the Burch urethropexy quoted in the literature include urinary tract infection (UTI), de novo detrusor overactivity, wound infection, voiding disorders, urinary tract injury, deep vein thrombosis, hemorrhage, fistula, wound complications, and suture erosion. Many intraoperative complications can be prevented with good surgical technique and adequate exposure. Postoperative complications require careful evaluation and management.