Introduction: The aim of the study was to evaluate the longterm efficacy of laser ablation of the prostate (using a freebeam technique) and its associated morbidity. Patients and methods: Between November 1992 and November 1995. a prospective study of 170 patients with symptomatic BPH (mean age 64.9 years, range 51-87) was conducted. Before starting therapy, a sextant prostatic biopsy was taken in all patients. NdiYAG laser energy was delivered using a side-firing 1 mm quartz fibre (Prolase II & I). Energy was delivered at 60 W for 60 s to various sectors, achieving deep coagulation necrosis. The patients were catheterized after treatment for 7 days. The mean prostatic volume was 34.4 g (range 22-64) and the mean laser energy delivered was 36.1 kj. The variables assessed comprised the IPSS. quality-of-life score (QoL), urinary flow rate (Qmax) and post-void residual volume (PVR). Results: The values of the variables assessed before treatment and during follow-up were; Mean Follow-up (years) (SD) Before 2 4 Number 170 119 37 IPSS 19.7(7) 6.4(5) 4.9(7) QoL 4.0(1) 1.6(1) 1.1(1) Qmax(mL/s) 9.0(4) 19.8(7) 15.3(4) PVR (mL) 121(110) 37(35) 22(30) For all values at 2 and 4 years, V < 0.001 vs. before treatment Early complications at 3 months were irritative symptoms in 24 (14%). haematuria in eight (5%), retention in seven (4%), stress incontinence in two (1%) and perineal pain in two (1%). Late complications at 6 months were bladder neck sclerosis in one (0.6%) and urethral stricture in one (0.6%). Of the 67% of patients who reported being sexually active before treatment. 34% reported retrograde ejaculation afterward. The mean hospital stay was 1.6 days (range 1-3). The re-operation rate was 4.7% in the first year (60% > 50 g prostate). 1% in the second and third year and none in the fourth year. Conclusions: The only significant morbidity was irritative symptoms. The 4-year follow-up results were satisfactory, with a low re-operation rate and short hospital stay. This laser application is most suitable for patients with BPH of < 50 g.