Background: Midurethral sling surgery is the current gold standard worldwide for stress urinary incontinence (SUI) surgery. However, concerns surround mesh-related adverse events associated with the midurethral sling. The decision to use the midurethral sling for surgical treatment has become a challenging one for clinicians, surgeons and patients. Objectives: We sought to determine the factors for 5-year complications after midurethral sling surgery, to improve the clinical decision-making process. Study Design: Records were reviewed from a total of 1,961 female patients who underwent their first midurethral sling surgery for SUI between 2003 and 2018 at a single teaching hospital in Taiwan. A multivariable Cox proportional hazard model calculated the hazard ratios of risk factors for surgical complications, after adjusting for confounders. Results: Surgical complications (i.e., secondary surgery and urinary retention) occurred in 93 (4.7%) patients within 5 years following the index operations. These patients were more likely to be older, to have a history of menopausal syndrome within 1 year prior to the index operation,hormone replacement therapy (HRT), slower average flow rate, and longer voiding time compared with patients without surgical complications. In the multivariate analysis, menopausal syndrome or HRT (adjusted hazard ratio, 1.794; 95% confidence interval, 1.055–3.050, p=0.0390) was significantly associated with surgical complications at 5 years, after adjusting for age, gender, diabetes, average flow rate, and sling type. Conclusion: Our findings suggest that a history of menopausal syndrome within 1 year prior to surgery or a medication history of HRT may be risk factors associated with surgical complications