Seth K. Bechis, MD

Seth K. Bechis, MD

University of California, San Diego

La Jolla, California

Seth K. Bechis, MD is a board-certified urologist specializing in diseases of the urinary tract, including kidney stones, benign prostatic hyperplasia (BPH) or enlarged prostate, and men's health issues. Dr. Bechis completed fellowship training in laparoscopy/robotics and endourology at the University of California (UC), San Diego School of Medicine, and residency training at Harvard Medical School, Massachusetts General Hospital in Boston. He earned his medical degree from UC San Francisco School of Medicine and holds additional Master of Science training in biomedical research, also from UC San Francisco, focusing on ways to prevent and treat diseases.

As a member of the Comprehensive Kidney Stone Center at UC San Diego Health, Dr. Bechis has a special interest in advanced surgical treatment, medical prevention, and research on kidney stone disease. He has surgical expertise in percutaneous nephrolithotomy (PCNL) for complex stones, ureteroscopy, and shockwave lithotripsy. Dr. Bechis specializes in all procedures of the prostate including minimally invasive procedures such as Rezum water vapor therapy and UroLift, as well as robotic surgery and GreenLight™ Laser photoselective vaporization of the prostate (PVP).

Dr. Bechis serves as the associate program director for the UC San Diego - Kaiser Laparoscopy/Endourology Fellowship in the Department of Urology at UC San Diego School of Medicine. His current research includes improving surgical techniques and clinical outcomes in stone disease, as well as tools for stone diagnosis and opiate-sparing pathways for managing pain. His research has been featured in peer-reviewed medical journals and he has authored chapters for university handbooks.

Prior to joining UC San Diego Health, Dr. Bechis worked at Massachusetts General Hospital and Harvard Medical School, where he taught residents and medical students in the operating room and clinic.

Talks by Seth K. Bechis, MD

Stone Volume is a Better Predictor of Spontaneous Stone Passage

Stone Volume is a Better Predictor of Spontaneous Stone Passage

Posted by | Oct 2024

Dr. Seth K. Bechis, MD, discusses the critical role of stone volume as a predictor of spontaneous stone passage in patients with urolithiasis. He emphasizes that while stone size has traditionally been considered the primary factor in determining the likelihood of spontaneous passage, emerging evidence suggests that stone volume offers a more accurate assessment. Dr. Bechis advocates for integrating this assessment into routine evaluation protocols.

In this 16-minute presentation, Dr. Bechis explains that stone volume, which accounts for both the size and the three-dimensional shape of the stone, provides a more comprehensive measure that correlates better with clinical outcomes. This is especially relevant in determining whether to pursue active intervention or adopt a more conservative, observational approach.

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Should MIST be First Line Treatment for BPH?

Should MIST be First Line Treatment for BPH?

Posted by | Sep 2024

Seth K. Bechis, MD, explores the question of whether or not minimally invasive surgical therapies (MIST) should be first line treatment for BPH. He begins by highlighting the prevalence of BPH in men over 60. He acknowledges that combination therapy is extremely effective in combating BPH in the short-term, but it has several long-term risks which impact patient QoL.

Dr. Bechis highlights the negative side-effects of 5-ARIs, alpha blockers, and surgery post-medication-failure. Side-effects included increased risk of cardiac failure, dementia, depression, and sexual dysfunction.

Dr. Bechis then examines current MIST procedures for BPH treatment, including prostatic urethral lifts, water vapor thermal therapy, temporarily implanted nitinol devices, and balloons. He examines the durability, effectiveness, and side-effects for each procedure, and compares them to patients on medication

Dr. Bechis concludes by comparing the cost effectiveness of MIST procedures to the cost of medication, taking into account IPSS improvement and Quality-Adjusted Life Years over time. Overall, he suggests that MIST procedures should be explored as a first line treatment for BPH.

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Emerging Topics in Ureteroscopy: Pressure, Temperature, and Suction

Emerging Topics in Ureteroscopy: Pressure, Temperature, and Suction

Posted by | Jul 2024

Seth K. Bechis, MD, discusses methods to reduce pain, sepsis, and other complications in the use of ureteroscopy to treat renal conditions. He begins by examining the relationship between intrarenal pressure (IRP), pain, and infection. He discusses the importance of monitoring IRP during ureteroscopy, and explores methods of reducing IRP, including irrigation control.

Dr. Bechis then discusses the issue of thermal injury in ureteroscopy. He illustrates the benefits of proper irrigation, shorter laser pedal activation time, and laser setting in preventing the denaturation of proteins in the kidney. He compares the temperatures generated by Holmium and TFL lasers, noting that TFL is a higher-energy option.

Dr. Bechis concludes by examining the role of suction in renal stone removal. He presents a demonstration of various suction devices and discusses their strengths and limitations. He warns that the use of a suction device lengthens the duration of the procedure and that suction still has room for improvement as a treatment.

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Should MIST be First Line Treatment for BPH?

Should MIST be First Line Treatment for BPH?

Posted by | Jun 2024

Seth K. Bechis, MD, explores the question of whether or not minimally invasive surgical therapies (MIST) should be first line treatment for BPH. He begins by highlighting the prevalence of BPH in men over 60. He acknowledges that combination therapy is extremely effective in combating BPH in the short-term, but it has several long-term risks which impact patient QoL.

Dr. Bechis highlights the negative side-effects of the 5-ARIs, alpha blockers, and surgery post-medication-failure. Side-effects included increased risk of cardiac failure, dementia, depression, and sexual dysfunction.

Dr. Bechis then examines current MIST procedures for BPH treatment, including prostatic urethral lifts, water vapor thermal therapy, temporarily implanted nitinol devices, and balloons. He examines the durability, effectiveness, and side-effects for each procedure, and compares them to patients on medication

Dr. Bechis concludes by comparing the cost-effectiveness of MIST procedures to the cost of medication, taking into account IPSS improvement and Quality-Adjusted Life Years over time. Overall, he suggests that MIST procedures should be explored as a first-line treatment for BPH.

Read More
Making Sense of BPH: Which Treatment for Which Patient – Review of Guidelines for BPH

Making Sense of BPH: Which Treatment for Which Patient – Review of Guidelines for BPH

Posted by | May 2024

Seth K. Bechis, MD, reviews the 2023 American Urological Association (AUA) guidelines for benign prostatic hyperplasia (BPH) treatment. Dr. Bechis begins by enumerating the currently available procedures for BPH treatment, with less invasive approaches favoring ease of use, minimal morbidity, and minimal ejaculatory problems versus the more invasive approaches favoring definitive efficacy and durability of results.

Dr. Bechis shares the 2023 AUA guidelines on surgical management of BPH and explains considerations for treatment choice include prostate size, presence of a median lobe, and preferences regarding sexual function. He covers guidelines for:

Prostatic Urethral Lifts
Water Vapor Thermal Therapy
Temporarily Implanted Prostatic Devices
Greenlight Photoselective Vaporization of the Prostate (PVP)
Drug-Eluting Catheters
Holmium Laser Enucleation of the Prostate (HoLEP)
Robotic Waterjet Treatment (Aquablation)

Dr. Bechis concludes by explaining how he counsels patients by reviewing the data together and involving them in shared decision-making. He stresses the importance of anticipating recovery pathways and post-op hurdles for each treatment.

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