Reconstructive pelvic floor surgery offers a wide range of surgical options for treating urinary incontinence, organ prolapse and other pelvic floor disorders. The aim is always to choose the safest and most effective procedure to improve the quality of life of those affected. In addition to expertise in making the appropriate diagnosis and surgical experience, knowledge of how to deal with complications is always essential. When categorising complications, a distinction is made between early and late complications, intraoperative and postoperative complications, and general and procedure-specific complications. If complications arise, conservative and surgical treatment options should be known. The starting point here is adequate diagnostics, which may include basic examinations, sonography, endoscopy and imaging techniques. The aim is to be able to accurately assess the extent of the complication in order to choose the appropriate therapy—preferably conservative methods. Particular challenges in the management of complications in reconstructive pelvic floor surgery are posed by complications with foreign materials. Surgical complication management can be very complex, requires a high level of surgical expertise and may also require an interdisciplinary approach. Gaining expertise in managing complications, whether conservative or surgical methods, can be challenging, especially when aiming to avoid causing those complications yourself.