Seth K. Bechis, MD, presented “Point-Counterpoint: HoLEP vs. GreenLightTM PVP – GreenLightTM PVP” during the 30th Annual Perspectives in Urology: Point-Counterpoint, on March 10, 2023, at Humphreys Half Moon Inn, San Diego, California.
How to cite: Bechis, Seth K. “Point-Counterpoint: HoLEP vs. GreenLightTM PVP – GreenLightTM PVP.” March 10, 2023. Accessed Jan 2026. https://grandroundsinurology.com/point-counterpoint-holep-vs-greenlighttm-pvp-greenlighttm-pvp/
Point-Counterpoint: HoLEP vs. GreenLightTM PVP–GreenLightTM PVP – Summary
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.”
About the 30th Annual Perspectives in Urology: Point Counterpoint conference: Presented by Program Chair and Grand Rounds in Urology Editor-in-Chief E. David Crawford, MD, this conference brought together leading experts in urology, medical oncology, and radiation oncology to discuss and debate the latest topics in genitourinary cancers, primarily prostate cancer and bladder cancer. This interactive conference offered topical lectures, pro/con debates, interesting-case presentations, interactive panel discussions, and interactive audience and faculty networking.
ABOUT THE AUTHOR
Seth K. Bechis, MD, MS, is an Associate Professor of Urology at the University of California, San Diego. 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. His current research focuses on improving surgical techniques and clinical outcomes in stone disease, as well as tools for stone diagnosis and opiate-sparing pathways for managing pain.
Dr. Bechis earned his Master’s of Science in Biomedical Sciences and his medical degree from the University of California, San Francisco. He completed his residency at Harvard University in Boston, Massachusetts. Dr. Bechis then completed a fellowship in Laparoscopy/Robotics and Endourology at the University of California, San Francisco.
Dr. Bechis is a member of several professional medical organizations, including the American Urological Association (AUA), the Endourological Society, and the Western Section of the AUA. He has won numerous awards and honors over the years, including the Whitehill Award for Excellence in Clinical Teaching in 2019, Plenary Address for Best Abstract from the American Urological Association in 2015, and first place in the 2014 Max K. Willscher Resident Research Award Competition. Dr. Bechis has been invited to speak nationally and internationally at conferences on topics including benign prostatic hyperplasia and stone disease. His research has been featured in peer-reviewed medical journals, including Journal of Urology, Journal of Endourology, and World Journal of Urology. Additionally, Dr. Bechis was editor of First Aid Q&A for the USMLE Step 1, Second Edition, and has authored chapters for university handbooks.
