Hysteropexy, the surgical procedure aimed at uterine preservation while correcting pelvic organ prolapse, has gained popularity worldwide, due to patient preference, decreased surgical morbidity, and the observation that with vaginal mesh placement. There are lower risks of vaginal mesh exposure if the uterus is left in situ. In the United States, transvaginal sacrospinous hysteropexy procedures entered the mainstream of urogynecology practice through the journey of transvaginal mesh kits. This chapter provides an overview of the potential complications associated with hysteropexy, based on a thorough review of the literature and expert opinion. We discuss important preoperative considerations for surgical decision-making for hysteropexy, and then review various surgical approaches including vaginal, abdominal, and laparoscopic methods, detailing their specific complications. The primary aim is a targeted strategy for troubleshooting and managing these complications while employing strategies for prevention. Insights into the emerging trends and comparison of hysteropexy with hysterectomy in terms of patient outcomes will contribute to a nuanced understanding of the procedure’s relevance in modern urogynecology.