Vaginal mesh complications have been in the FPMRS zeitgeist from the last 10 years. Pelvic surgeons have had to address this controversy head on over the last decade. When considering the higher rate of complications related to the use of synthetic mesh for vaginal prolapse, there have been two main schools of thought. The first school of thought subscribes to the general belief that synthetic mesh placed inside the vagina is prone to causing pain and extrusion/erosion. The other camp believes that the lion’s share of issues related to synthetic mesh lies squarely on the shoulders of poor surgical technique at the hands of improperly trained or inexperienced surgeons. Irrespective of which group one may identify with at this point, synthetic mesh used in the surgical treatment of pelvic organ prolapse does require special consideration. In this chapter, we will review techniques for avoiding complications, recognizing technical issues intraoperatively, and managing complications postoperatively.