In a review of the literature on the perioperative complications of Burch colposuspension we found only sparse data associated with this problem. We describe our own experience (> 1800 procedures) and the literature, discussing bleeding/hematoma, injury to the bladder, kinking/injury to the ureters, voiding dysfunction, infection, and rare complications such as deep venous thrombosis, pulmonary embolism, ileus, sepsis, external iliac vein injury and mortality rate. Knowledge of the possible risks and complications of Burch colposuspension may minimize the intraoperative complications and increase postoperative surgical success and patient satisfaction.