The prevalence of pelvic organ prolapse (POP) is increasing with age. The gradual process of aging all over the world makes the management of POP in elderly patient a real public health challenge. Treatment of POP in patients older than 70 years is based on surgery or conservative procedure such as pessary. Because of diseases associated with their POP, many intra or post operative complications may occur, therefore why conservative procedures are mostly preferred. In our country, pessary is not used commonly. The aim of this study is to show that surgical procedure might be a good solution for elderly patients.
This is a retrospective, descriptive study made in our department during a 8 years period. All data were collected from patient’s files.

We report a series of 77 women older than 70 years operated over a period of 8 years from January 2009 until September 2017. In the same period, 267 women underwent a vaginal reconstructive surgery for POP. The patients age, medical history, the initial reported symptom, the POP’s classification (Baden and Walker classification was used), the association with urinary incontinence, the type of surgical procedure, the occurrence of intra or postoperative complications, the satisfaction of patients and the operating time were reported. Before they leave hospital, all patients were asked about their satisfaction degree.

We report a series of 77 patients older than 70 years and presenting a POP. They underwent a vaginal reconstructive surgery. No intra operative complication was reported. Two cases were complicated postoperatively (a hematoma and a pulmonary embolism). The mean surgical time was 65 minutes. All patients were operated under loco regional anesthesia and in one case a conversion to a general anesthesia was needed. The mean hospital stay was 48 hours in 76 cases. All patients noted their satisfaction after surgery. This study shows that surgery is a safe way to treat POP in elderly women especially if conservative device (pessary) is not within the reach of all women.

The prevalence of pelvic organ prolapse varies between 2.9 and 11.4 % in questionnaire-based studies and from 31.8 to 97.7 % according to the ICS Pelvic Organ Prolapse Classification (POPQ).
Conservative procedure such pessary is preferred to surgical management in older patients with high risk due to medical status. This alternative is not out of complication. Many complications were reported in several publications such as vaginal erosion, patient discomfort and vaginal infection. 
In addition, the high cost of the pessary, the fact that it is not covered by health insurance, the frequent illiteracy of this population and sometimes the lack of medical follow-up make this alternative an expensive and temporary procedure. All these arguments make the surgical treatment the gold standard of the management of the POP in older women in our country. 
This study shows an insignificant complication rate. No deaths were noted. The only major complication was pulmonary embolism. Comparing between complication rates after vaginal reconstructive surgery for POP in two populations (older than 70 years women and young women) many authors reported similar results.

In elderly women, vaginal reconstructive surgery is a safe choice to treat pelvic organ prolapse. 
this surgery which remains functional must be well prepared by a good selection of patients, a good indication and a good pre-anesthetic preparation