We describe the clinical experience with a self-expanding prostatic stent used in patients with bladder outlet obstruction and advanced comorbid medical illness. A Gianturco-Z stent was placed in 25 men, including 21 in urinary retention. Patients were followed clinically and with serial endoscopy. Mean age was 80.5 years (range 54 to 98). Mean followup was 10.1 months, with a longest followup of 24 months. Spontaneous voiding resumed in 20 of 21 patients (95%) with retention, with 16 of 21 (76%) demonstrating long-term success. Two patients failed due to stent migration within 1 month. Other complications were limited to minor stent incrustations in 2 cases, symptomatic urinary infections without fever in 2 and epididymitis occurring 15 months following stent placement in 1. No perioperative cardiovascular complications were encountered. Followup endoscopy revealed partial stent coverage by urothelium in 13 of 16 men at 1 month and greater than 90% coverage in 8 of 13 by 3 months. The high success rate with minimal morbidity observed suggests that prostatic stents may become the first-line therapy for the medically compromised man with bladder outlet obstruction.