Seth K. Bechis, MD, presented “Point-Counterpoint: Holmium vs. Thulium Laser – Holmium” 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: Holmium vs. Thulium Laser – Holmium.” March 10, 2023. Accessed Feb 2026. https://grandroundsinurology.com/point-counterpoint-holmium-vs-thulium-laser-holmium/
Point-Counterpoint: Holmium vs. Thulium Laser – Holmium – Summary
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.”
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.
