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.

Disclosures:

Talks by Seth K. Bechis, MD

Point-Counterpoint: HoLEP vs. GreenLightTM PVP – GreenLightTM PVP

Point-Counterpoint: HoLEP vs. GreenLightTM PVP – GreenLightTM PVP

Posted by | Nov 2023

Seth K. Bechis, MD, compares GreenLightTM photosensitive vaporization of the prostate (PVP) to holmium laser enucleation of the prostate (HoLEP,) illustrating how PVP can safely and effectively treat benign prostatic hyperplasia (BPH) in small and large prostates. Dr. Bechis first establishes BPH prevalence and expenses. He then cites American Urological Association (AUA) guidelines on the surgical management of BPH, noting that PVP may be used on small and average prostates.

Dr. Bechis explains that large prostates are also good candidates for PVP, and PVP can offer an advantage for patients on anticoagulation. Dr. Bechis then emphasizes that 180-watt laser use contributes to properly, safely, and durably treating BPH and creating functional outcomes after two years, regardless of prostate size. He compares data between PVP outcomes on small and large prostates, reviewing differences in operative time, lasering time, and energy per unit volume of the prostate. He evaluates the similar data found between small and large prostates treated with PVP, including hospital stay, quality of life, and International Prostate Symptom Score (IPSS).

Dr. Bechis then explores a 2017 study that found that PVP creates durable results at four years, provided that energy density remains at 3 KJ/cc or higher. Dr. Bechis also stresses that keeping the retreatment rate low for PVP depends on using the correct energy density. He continues by noting that there are fewer complications with PVP compared to HoLEP. Dr. Bechis completes his discussion by examining PVP’s relatively simpler learning curve and proficiency maintenance while also highlighting PVP as a financially sound option in BPH treatment.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: HoLEP vs. GreenLightTM PVP – HoLEP.”

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Point-Counterpoint: Holmium vs. Thulium Laser – Holmium

Point-Counterpoint: Holmium vs. Thulium Laser – Holmium

Posted by | Oct 2023

Seth K. Bechis, MD, discusses concerns with thulium fiber lasers (TFLs) and highlights holmium laser capabilities and their benefits. He opens by reviewing laser procedure terminology and noting the holmium laser’s increased reliability in comparison to TFL. Dr. Bechis analyzes misconceptions of TFL frequency capabilities and examines the pulse features of holmium lasers. He highlights pulse modulation in holmium lasers, a feature that allows urologists to reduce retropulsion.

He continues by examining the short and long pulse settings of holmium lasers, emphasizing that issues associated with short pulse fire, such as retropulsion and fiber degradation, can be solved with long pulse. Dr. Bechis discusses the variety offered by holmium lasers and eases concerns associated with the holmium laser’s special circuit requirements. He reviews MOSES pulsed laser modulation and similar technology.

He also explores different stone treatment methods, including fragmenting, dusting, and popcorning. Dr. Bechis stresses the significance of popcorning, noting that the holmium laser surpasses TFL in this technique and provides the retropulsion level necessary for effective fragmentation. He then reviews advantages and disadvantages of dusting, fragmenting, and popcorning, leading to a discussion on whether dusting or fragmenting is preferable in stone treatment.

After reviewing multiple studies, including a study from the EDGE Research Consortium, Dr. Bechis notes that there is no clear winner between dusting and fragmenting and pinpoints caveats to the literature on the subject. He then analyzes thermal injury concerns with TFL. Dr. Bechis concludes with a focus on the holmium laser’s ability to maximize efficient power and minimize heat, explaining TFL’s relative inefficiency and additional heat concerns.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Holmium vs. Thulium Laser–Thulium.”

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Point-Counterpoint: Next Generation Sequencing vs. Standard Culture – Next Generation Sequencing

Point-Counterpoint: Next Generation Sequencing vs. Standard Culture – Next Generation Sequencing

Posted by | Sep 2023

Seth K. Bechis, MD, expresses concerns with standard urine cultures and discusses the efficacy and efficiency of next generation sequencing. Dr. Bechis first examines standard urine cultures, noting their 30%-50% diagnostic error rate. He outlines other shortcomings of standard urine cultures, including their expensive and relatively slow process, inaccurate contamination results, unclear threshold for positive tests, and additional error rates.

Dr. Bechis cites two studies in which researchers discovered inaccuracies in urine culture results for clinically suspected UTI patients and women with dysuria. He then discusses polymerase chain reaction-based (PCR-based) assays and next generation sequencing (NGS). He highlights an advantage of this combination, explaining that it can detect every organism in a sample. Dr. Bechis evaluates PCR-based assays and NGS further and explains their ability to identify both bacteria and fungi.

He supports NGS technology by introducing three examples that compare standard urine cultures to NGS. These examples address UTI patients, cystitis patients, and renal stone patients.

Dr. Bechis highlights the increased detection capabilities of NGS compared to standard urine cultures, noting that NGS can even lead to better treatment and more appropriate antibiotic use. He also explores a pilot study that compared urine cultures to NGS and found that 80%–90% of physicians would have changed their preoperative antibiotics approach based on NGS results. Dr. Bechis completes his discussion by reviewing NGS benefits, advocating for NGS implementation in practice.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Next Generation Sequencing vs. Standard Culture–Standard Culture.”

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