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Papers by Jason Joseph

This Honors Thesis-Open Access is brought to you for free and open access by the Lee Honors Colle... more This Honors Thesis-Open Access is brought to you for free and open access by the Lee Honors College at ScholarWorks at WMU. It has been accepted for inclusion in Honors Theses by an authorized administrator of ScholarWorks at WMU. For more information, please contact

The Journal of Sexual Medicine, 2020

Background A randomized, controlled clinical trial evaluating the efficacy of RestoreX traction t... more Background A randomized, controlled clinical trial evaluating the efficacy of RestoreX traction therapy in men with Peyronie’s disease (PD) has been completed, with the 3-month results previously reported. The present study presents outcomes from the open-label and follow-up phases of the original trial. Aim To report 6-month (open-label phase) and 9-month (follow-up phase) outcomes from a randomized, controlled trial (NCT03389854). Methods A randomized controlled trial was performed from 2017 to 2019 in 110 all-comer men with PD. Men were randomized 3:1 to RestoreX (PTT) or no therapy (control) for 3 months, followed by 3-month open-label and follow-up phases. Key outcomes included adverse events (AEs), changes in penile curvature and length, erectile function, and standardized and nonstandardized assessments of PD. Outcomes The primary outcomes are safety, penile length, penile curvature, Peyronie’s Disease Questionnaire, International Index of Erectile Function, and satisfaction....

Colorectal Disease, 2020

AimUp to 10% of patients who undergo nonurological abdominopelvic operations suffer a ureteral in... more AimUp to 10% of patients who undergo nonurological abdominopelvic operations suffer a ureteral injury. While preoperative ureteral stenting to facilitate identification of the ureter is common, it does not reduce the incidence of intraoperative ureteral injury and is not without risk. As we continue to broaden the application of minimally invasive surgical techniques, a new form of ureteral identification and avoidance that does not rely on tactile feedback is needed. We report our initial experience with intraureteral indocyanine green (ICG) for ureteral identification and avoidance during complex robotic‐assisted colorectal surgery.MethodPatients undergoing adjunctive ureteral identification during robotic‐assisted colorectal surgery were prospectively identified. Each patient underwent intraureteral ICG administration using rigid cystoscopy (22 Fr). A 5‐Fr open‐ended ureteral catheter was inserted up to 20 cm and used to inject 5 ml of 2.5 mg/ml ICG as the catheter was withdrawn ...

Translational Andrology and Urology, 2020

Journal of Urology, 2019

predominantly male (50,139 [62.2%]). All modalities of urologic surgery were associated with incr... more predominantly male (50,139 [62.2%]). All modalities of urologic surgery were associated with increased rates of new persistent opioid use at each follow up interval compared to the control sample (p <0.0001). Prevalence of persistent opioid use across the discrete time intervals ranged from 4.72-5.27%, 5.52-6.54%, 8.20-8.80% and 3.46-3.80% for abdominal, endoscopic, percutaneous, and scrotal/penile/perineal/vaginal procedures, respectively. In the non-operative cohort, rates of new opioid use ranged from 3.26-3.59%. There were no clear trends over time in any group. Preoperative risk factors independently associated with persistent opioid use included tobacco use (OR 1.33; 95% CI 1.24-1.44), substance use disorders (OR 1.36; 95% CI 1.08-1.69), any mental health, substance, or pain-related diagnoses (!3 diagnoses: OR 1.89; 95% CI 1.77-2.01), Charlson comorbidity index (!2: OR 1.29; 95% CI 1.21-1.37), and total initial opioid prescription !300 morphine milligram equivalents (OR 1.35; 95% CI 1.26-1.45). CONCLUSIONS: A meaningful fraction of previously opioidnaive patients receiving outpatient opioid analgesia following urologic procedures will go on to develop persistent opioid use. The data reinforce a national need amongst urologists to reduce post-operative opioid usage and validate recent efforts to adopt multimodal narcoticfree pathways.

Journal of Urology, 2019

One-year data indicates the Optilumeä DCB treatment is safe and the device produces urethra lumin... more One-year data indicates the Optilumeä DCB treatment is safe and the device produces urethra luminal gain that achieves significant clinical results with meaningful increased Qmax and decreased IPSS.

Journal of Urology, 2019

factors, and impact of CDI on perioperative outcomes in urologic surgery. METHODS: The American C... more factors, and impact of CDI on perioperative outcomes in urologic surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database tracts 30-day hospital readmission, reoperation, death, and complications, including CDI, from participating institutions. We identified CPT codes of patients undergoing the breadth of urologic surgery, which we characterized into 12 surgical categories (Figure 1). Univariate analysis was used to compare preoperative and operative parameters associated with the outcomes of interest (CDI, readmission, and death). Variables that were significant or near significant were entered into a multivariable backwards stepwise logistic regression model. All tests were 2 sided and significance was set at p[0.05. RESULTS: From 2015-2016, we identified 83,646 patients with urology associated CPT codes, of which 281 patients (0.3%) developed postoperative CDI. CDI was highest in patients undergoing urinary diversion with (2.6%) or without cystectomy (3.6%), Figure 1. In the multivariable model, male gender was protective against CDI (OR 0.657, 95% CI 0.452-0.925, p[0.017) while low serum albumin (<3.5mg/dL) and elevated serum creatinine (>1.5mg/dL) were associated with CDI (OR 1.89, 95% CI 1.33-2.68, p<0.001, and OR 1.89, 95% CI 1.29-2.89, p[0.001, respectively). Increasing age per year (OR 1.02, 95% CI 1.001-1.03, p[0.03), operative time per minute (OR 1.002, 95% CI 1.001-1.003, p[0.001), and postoperative length of stay (OR 1.054, 95% CI 1.039-1.070, p<0.001) were each associated with the development of CDI. CDI was significantly associated with 30-day hospital readmission (OR 4.24, 95% CI 3.04-5.91, p<0.001) and 30day mortality (OR 4.35, 95% CI 2.26-8.35, p<0.001). CONCLUSIONS: Although, CDI is relatively uncommon in most urologic surgery, there is significant morbidity and mortality associated with CDI. Awareness of predisposing risk factors may provide insight to decrease the incidence and impact of CDI.

The Journal of Urology, 2018

Journal of Urology, 2018

P<0.001), and higher UR rates (5% vs 3.3% c¼5.396 p¼0.02) ,but no difference in URO, compared to ... more P<0.001), and higher UR rates (5% vs 3.3% c¼5.396 p¼0.02) ,but no difference in URO, compared to ureteroscopy for stricture managements CONCLUSIONS: Identifying the most common complications leading to early postoperative readmissions and reoperation after major endourologic surgeries is essential. Analyses of NSQIP data as a large national patient population provide a benchmark to help hospitals and surgeons improve the quality of patients care

The Journal of Urology, 2018

ratio (HR) ¼ 0.89, CI ¼ 0.78, 0.93) compared to white patients. Hospital competition was associat... more ratio (HR) ¼ 0.89, CI ¼ 0.78, 0.93) compared to white patients. Hospital competition was associated with improved quality of care and outcomes, and contributed to the racial and ethnic disparity. CONCLUSIONS: This novel study showed that higher competition hospitals have positive implications for outcomes among patients with prostate cancer. Additional research is needed to identify the mechanism through which hospital competition affects prostate cancer care outcomes.

The Journal of Urology, 2016

found in the internal iliac region. 96% of patients with positive nodes are correctly staged in c... more found in the internal iliac region. 96% of patients with positive nodes are correctly staged in case a standard ePLND and sePLND should be tailored for selected patients.

This report was generated by a group of engineering seniors at Western Michigan University. It is... more This report was generated by a group of engineering seniors at Western Michigan University. It is primarily a record of a project conducted by these students as part of curriculum requirements for being awarded an engineering degree. Western Michigan University makes no representation that the material contained in this report is error free or complete in all respects. Therefore, Western Michigan University, its faculty, its administration or the students make no recommendation for use of said material and take no responsibility for such usage. Thus persons or organizationswho choose to use said material for such usage do so at their own risk.

This Honors Thesis-Open Access is brought to you for free and open access by the Lee Honors Colle... more This Honors Thesis-Open Access is brought to you for free and open access by the Lee Honors College at ScholarWorks at WMU. It has been accepted for inclusion in Honors Theses by an authorized administrator of ScholarWorks at WMU. For more information, please contact

The Journal of Sexual Medicine, 2020

Background A randomized, controlled clinical trial evaluating the efficacy of RestoreX traction t... more Background A randomized, controlled clinical trial evaluating the efficacy of RestoreX traction therapy in men with Peyronie’s disease (PD) has been completed, with the 3-month results previously reported. The present study presents outcomes from the open-label and follow-up phases of the original trial. Aim To report 6-month (open-label phase) and 9-month (follow-up phase) outcomes from a randomized, controlled trial (NCT03389854). Methods A randomized controlled trial was performed from 2017 to 2019 in 110 all-comer men with PD. Men were randomized 3:1 to RestoreX (PTT) or no therapy (control) for 3 months, followed by 3-month open-label and follow-up phases. Key outcomes included adverse events (AEs), changes in penile curvature and length, erectile function, and standardized and nonstandardized assessments of PD. Outcomes The primary outcomes are safety, penile length, penile curvature, Peyronie’s Disease Questionnaire, International Index of Erectile Function, and satisfaction....

Colorectal Disease, 2020

AimUp to 10% of patients who undergo nonurological abdominopelvic operations suffer a ureteral in... more AimUp to 10% of patients who undergo nonurological abdominopelvic operations suffer a ureteral injury. While preoperative ureteral stenting to facilitate identification of the ureter is common, it does not reduce the incidence of intraoperative ureteral injury and is not without risk. As we continue to broaden the application of minimally invasive surgical techniques, a new form of ureteral identification and avoidance that does not rely on tactile feedback is needed. We report our initial experience with intraureteral indocyanine green (ICG) for ureteral identification and avoidance during complex robotic‐assisted colorectal surgery.MethodPatients undergoing adjunctive ureteral identification during robotic‐assisted colorectal surgery were prospectively identified. Each patient underwent intraureteral ICG administration using rigid cystoscopy (22 Fr). A 5‐Fr open‐ended ureteral catheter was inserted up to 20 cm and used to inject 5 ml of 2.5 mg/ml ICG as the catheter was withdrawn ...

Translational Andrology and Urology, 2020

Journal of Urology, 2019

predominantly male (50,139 [62.2%]). All modalities of urologic surgery were associated with incr... more predominantly male (50,139 [62.2%]). All modalities of urologic surgery were associated with increased rates of new persistent opioid use at each follow up interval compared to the control sample (p <0.0001). Prevalence of persistent opioid use across the discrete time intervals ranged from 4.72-5.27%, 5.52-6.54%, 8.20-8.80% and 3.46-3.80% for abdominal, endoscopic, percutaneous, and scrotal/penile/perineal/vaginal procedures, respectively. In the non-operative cohort, rates of new opioid use ranged from 3.26-3.59%. There were no clear trends over time in any group. Preoperative risk factors independently associated with persistent opioid use included tobacco use (OR 1.33; 95% CI 1.24-1.44), substance use disorders (OR 1.36; 95% CI 1.08-1.69), any mental health, substance, or pain-related diagnoses (!3 diagnoses: OR 1.89; 95% CI 1.77-2.01), Charlson comorbidity index (!2: OR 1.29; 95% CI 1.21-1.37), and total initial opioid prescription !300 morphine milligram equivalents (OR 1.35; 95% CI 1.26-1.45). CONCLUSIONS: A meaningful fraction of previously opioidnaive patients receiving outpatient opioid analgesia following urologic procedures will go on to develop persistent opioid use. The data reinforce a national need amongst urologists to reduce post-operative opioid usage and validate recent efforts to adopt multimodal narcoticfree pathways.

Journal of Urology, 2019

One-year data indicates the Optilumeä DCB treatment is safe and the device produces urethra lumin... more One-year data indicates the Optilumeä DCB treatment is safe and the device produces urethra luminal gain that achieves significant clinical results with meaningful increased Qmax and decreased IPSS.

Journal of Urology, 2019

factors, and impact of CDI on perioperative outcomes in urologic surgery. METHODS: The American C... more factors, and impact of CDI on perioperative outcomes in urologic surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database tracts 30-day hospital readmission, reoperation, death, and complications, including CDI, from participating institutions. We identified CPT codes of patients undergoing the breadth of urologic surgery, which we characterized into 12 surgical categories (Figure 1). Univariate analysis was used to compare preoperative and operative parameters associated with the outcomes of interest (CDI, readmission, and death). Variables that were significant or near significant were entered into a multivariable backwards stepwise logistic regression model. All tests were 2 sided and significance was set at p[0.05. RESULTS: From 2015-2016, we identified 83,646 patients with urology associated CPT codes, of which 281 patients (0.3%) developed postoperative CDI. CDI was highest in patients undergoing urinary diversion with (2.6%) or without cystectomy (3.6%), Figure 1. In the multivariable model, male gender was protective against CDI (OR 0.657, 95% CI 0.452-0.925, p[0.017) while low serum albumin (<3.5mg/dL) and elevated serum creatinine (>1.5mg/dL) were associated with CDI (OR 1.89, 95% CI 1.33-2.68, p<0.001, and OR 1.89, 95% CI 1.29-2.89, p[0.001, respectively). Increasing age per year (OR 1.02, 95% CI 1.001-1.03, p[0.03), operative time per minute (OR 1.002, 95% CI 1.001-1.003, p[0.001), and postoperative length of stay (OR 1.054, 95% CI 1.039-1.070, p<0.001) were each associated with the development of CDI. CDI was significantly associated with 30-day hospital readmission (OR 4.24, 95% CI 3.04-5.91, p<0.001) and 30day mortality (OR 4.35, 95% CI 2.26-8.35, p<0.001). CONCLUSIONS: Although, CDI is relatively uncommon in most urologic surgery, there is significant morbidity and mortality associated with CDI. Awareness of predisposing risk factors may provide insight to decrease the incidence and impact of CDI.

The Journal of Urology, 2018

Journal of Urology, 2018

P<0.001), and higher UR rates (5% vs 3.3% c¼5.396 p¼0.02) ,but no difference in URO, compared to ... more P<0.001), and higher UR rates (5% vs 3.3% c¼5.396 p¼0.02) ,but no difference in URO, compared to ureteroscopy for stricture managements CONCLUSIONS: Identifying the most common complications leading to early postoperative readmissions and reoperation after major endourologic surgeries is essential. Analyses of NSQIP data as a large national patient population provide a benchmark to help hospitals and surgeons improve the quality of patients care

The Journal of Urology, 2018

ratio (HR) ¼ 0.89, CI ¼ 0.78, 0.93) compared to white patients. Hospital competition was associat... more ratio (HR) ¼ 0.89, CI ¼ 0.78, 0.93) compared to white patients. Hospital competition was associated with improved quality of care and outcomes, and contributed to the racial and ethnic disparity. CONCLUSIONS: This novel study showed that higher competition hospitals have positive implications for outcomes among patients with prostate cancer. Additional research is needed to identify the mechanism through which hospital competition affects prostate cancer care outcomes.

The Journal of Urology, 2016

found in the internal iliac region. 96% of patients with positive nodes are correctly staged in c... more found in the internal iliac region. 96% of patients with positive nodes are correctly staged in case a standard ePLND and sePLND should be tailored for selected patients.

This report was generated by a group of engineering seniors at Western Michigan University. It is... more This report was generated by a group of engineering seniors at Western Michigan University. It is primarily a record of a project conducted by these students as part of curriculum requirements for being awarded an engineering degree. Western Michigan University makes no representation that the material contained in this report is error free or complete in all respects. Therefore, Western Michigan University, its faculty, its administration or the students make no recommendation for use of said material and take no responsibility for such usage. Thus persons or organizationswho choose to use said material for such usage do so at their own risk.