Introduction. The main method of surgical treatment of stress urinary incontinence is using a free suburethral sling. This operation is deceptively considered simple, the technique of which does not require a long time to master, and the individual anatomy of the female pelvis is not taken into account. The consequence of this is an increase in the number of intra- and postoperative complications. Postoperative complications are more often described in the literature, so we decided to emphasize intraoperative injuries, their prevention and treatment methods.

Materials and methods. A retrospective study of 1 985 patients included traditional midurethral slings for the treatment of stress urinary incontinence. from 2019 to 2023 was conducted in the clinic of Urology of MSUMD on the basis of the Clinical Hospital named after S.I. Spasokukotsky.

Results. Trauma to the vaginal vaults occurred in 70 patients during the operation. Bladder perforation occurred in 58 cases. Significant bleeding (more than 500 ml) was recorded in only 1 case. Injury to the branches of the obturator nerve occurred in 60 patients. Injuries to the urethra or intestine were never observed during operations. Detailed recommendations for performing sling surgery techniques to reduce the number of complications are provided.

Conclusion. Midurethral sling operations should be performed by an experienced specialist in a specialized facility. It is important that all stages of the operation are clearly observed, regardless of the surgeon's experience. A clear understanding of the individual variability of the female pelvic anatomy is necessary in order to always be able to anticipate the risk of traumatization of nearby structures.