Objective: To determine the long–term efficacy and complications of visual laser coagulation/ ablation, VLAP (side–firing fibre) and direct contact laser ablation, CLAP (sapphire–tipped fibre) of the prostate in the treatment of benign prostatic hyperplasia (BPH).Patients and Methods: Patients with clinical BPH, obstructed at voiding cystometry, were recruited and randomised to undergo either CLAP (21 patients) or VLAP (17 patients). At baseline, 1, 6, 12 and 24 months, patients underwent clinical evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, post–void residual urine volume, and pressure/flow urodynamics. Results: The mean operating time for CLAP was 37.7 min and 24.5 min for VLAP. There was minimal morbidity with only 5 men requiring bladder irrigation after CLAP, 1 of whom had a blood transfusion. No patient required irrigation after VLAP. The mean catheterisation time after CLAP was 4.5 days (range 1–31 days) and 13.2 days (range 7–70 days) after VLAP. IPSS and Qmax improved significantly and maintained at 2 years. After CLAP, the IPSS decreased from 20.9 to 13.5 at 2 years while Qmax rose from 10 to 15.5 ml/s at 2 years. After VLAP, the IPSS decreased from 21.8 to 13.3 at 2 years while Qmax rose from 10 to 15.9 ml/s. There was no difference between CLAP and VLAP. Pressure/flow urodynamics at 6 months showed reduced bladder outflow obstruction.Conclusions: CLAP and VLAP offer the same improvement in flow rates and symptoms at 2years. Both procedures lead to minimal morbidity, but the excellent haemostasis that is achieved at VLAP makes it of more use in treating patients at high risk of haemorrhage after surgery.

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