The autologous pubovaginal sling (PVS) continues to represent an efficacious anti-incontinence procedure to address both uncomplicated and complex stress urinary incontinence (SUI) and is an important tool for any reconstructive urologist. Adverse events from this surgical procedure have been well described over the past nearly four decades, and severe complications are rare. The scope of this chapter was to describe the complications of autologous pubovaginal and their management. These adverse events are the result of inadvertent injury to adjacent pelvic structures, which are ideally addressed and repaired intraoperatively. Immediate postoperative lower urinary symptoms are very common during the first days or weeks after surgery, and these usually resolve with time. However, a subset of patients may require sling revision surgery for ongoing bladder obstruction.