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.

Neal DE: The National Prostatectomy Audit. Br J Urol 1997;79(suppl 2):69–75.
Emberton M, Neal DE, Black N, Fordham M, Harrison M, McBrien MP, Williams RE, McPherson K, Devlin HB: The effect of prostatectomy on symptom severity and quality of life. Br J Urol 1996;77:233–247.
Malenka DJ, Roos N, Fisher ES, McLerran D, Whaley FS, Barry MJ, Bruskewitz R, Wennberg JE: Further study of the increased mortality following transurethral prostatectomy: A chart–based analysis. J Urol 1990;144: 224–228.
Keoghane SR, Cranston DW, Lawrence KC, Doll HA, Fellows GJ, Smith JC: The Oxford Laser Prostate Trial: A double–blind randomized controlled trial of contact vaporization of the prostate against transurethral, preliminary results. Br J Urol 1996;77(3):382–385.
Kabalin JN: Laser prostatectomy is a safer, better operation than electrovaporization of the prostate. Urology 1997;49(2):160–165.
Donovan JL, Brookes ST, Kennedy LG, Abrams P, Peters TJ, Neal DE: The CLasP randomised controlled trial: Comparing laser therapy, conservative management and TURP for men with lower urinary tract symptoms. J Urol 1998;159(5):248.
Kabalin JN, Bite G, Doll S: Neodymium:YAG laser coagulation prostatectomy: 3 years of experience with 227 patients. J Urol 1996;155: 181–185.
Kabalin JN, Gill HS: Dosimetry studies utilizing the Urolase right angle firing neodymium: YAG laser fiber. Lasers Surg Med 1994;14: 145–154.
Cowles RSI, Kabalin JN, Childs S, Lepor H, Dixon C, Stein B, Zabbo A: A prospective randomized comparison of transurethral resection to visual laser ablation of the prostate for the treatment of benign prostatic hyperplasia. Urology 1995;46(2):155–160.
Costello AJ, Lusaya DG, Crowe HR: Transurethral laser ablation of the prostate – long–term results. World J Urol 1995;13:119– 122.
Hancock A, Keoghane SR, Turner K, Doll HA, Lawrence KC, Cranston DW: Two year data from the Oxford Laser Prostate Trial: A Double blind randomised controlled trial of TURP and contact laser prostatectomy. J Urol 1997;157 (4):40.
James MJ, Harris DR, Ceccherini A, Manhire AR, Bates CP: A urodynamic study of laser ablation of the prostate and a comparison of techniques. Br J Urol 1995;76:179–183.
Beerlage HP, Francisca EAE, d’Ancona FCH, Debruyne FMJ, de la Rosette JJMCH: Urolase vs. Ultraline fibres in laser prostatectomy: 3–year follow–up of a randomized study. J Endourol 1998;12(6):575–580.
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