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DEAR DR. ROACH: I would be interested in your thoughts regarding the use of Botox injections or stents to relieve the effects of BPH. — B.T.

ANSWER: BPH is benign prostatic hyperplasia — enlargement of the prostate gland. It is nearly universal in older men. Its symptoms vary, but often it causes difficulty in urinating. First line treatment is usually medication, but for men who don’t do well or can’t take medication, there are a variety of surgical options. These include lasers, and heating and freezing the prostate tissue. Botox and stenting have been evaluated as additional options.

Botulinum toxin (Botox and others) paralyzes muscles for a prolonged period. Because the prostate has muscle tissue (a special kind of muscle called smooth muscle), botulinum toxin has been tried and initially seemed effective. However, two large trials randomized men to botulinum toxin versus saline, where neither the doctor nor the patient knew what they were getting. The results showed that saline was just as effective. Botulinum toxin has not gotten much attention since, though it may still be useful in some men who can’t tolerate other options.

A urethral stent is a plastic or metal tube placed in the part of the urethra that goes through the prostate gland. In theory, these hold the urethra open and make it easier to urinate. While studies have shown benefit, not everyone had a good outcome. The stent may become dislodged or infected, and about a third of men needed to have the stents removed, which often proved difficult. Efforts continue to find better materials and techniques, but at this writing, urethral stenting is not the best option for most men with BPH.