Anterior compartment repair has high success rates with a low incidence of complications. Given the rarity of these events, there is a paucity of literature focusing on complications after native tissue anterior repairs without concomitant procedures. We review the most common complications and data in the literature. Complications include injury to the bladder or ureters, which require prompt recognition and repair to avoid further sequelae. Hemorrhage may also occur, which can be avoided with careful dissection of the anterior vaginal wall and fibromuscular layer, and judicious use of electrocautery. Some patients can experience de novo stress incontinence, which may be avoided with preoperative assessment with pelvic organ prolapse reduction on exam or under urodynamic testing and concomitant repair at the time of surgery. Lastly, there is also a risk of bladder outlet obstruction, which can be monitored postoperatively by assessing post-void residual (PVR) and patient symptoms.