Joseph A Costa, DO

Joseph Costa, DO, graduated medical school from the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific in 1991. He then served as a Naval Flight Surgeon for three years prior to resuming his residency in urology at the Naval Medical Center Portsmouth, Virginia. After residency, he completed a fellowship in male and female pelvic reconstructive surgery, trauma and neurourology at the University of Iowa.

In addition to completing his urology board certification in 2002, Dr. Costa completed certification in female pelvic medicine and reconstructive surgery in 2013. Over the past four years, he has become very involved with International Volunteers in Urology (IVU) Med and is an active board member. In the same amount of time, he has travelled to Haiti more than six times to work in vesicovaginal fistula and male urethral reconstruction workshops with Haitian surgeons. Dr. Costa also is a board member of the Florida Urological Society.

He is credentialed at five hospitals in the greater Jacksonville area; his primary clinical and academic work is in pelvic reconstructive surgery and neurourology. He has been with the University of Florida in Jacksonville since 2003.

While at UF, Dr. Costa has become increasingly active in executive leadership. From 2014 to 2016, he served as the interim chair of the Department of Surgery. During that time, he was responsible for a $38 million budget and the operational practice of 35 surgeons, 29 residents and 3 fellows. Dr. Costa has also been the Assistant Dean for Medical Informatics for the UF Jacksonville practice plan since 2012. He has been involved with the build, implementation, maintenance and growth of the Epic medical record system for a practice of 450+ providers.

My clinical responsibilities consist of the full spectrum of adult urologic disease; however, as a result of my fellowship training and academic interests, I have developed a specialty practice in Neurourology and Pelvic Reconstructive Surgery. Patients that I care for include those with congenital or traumatic spinal cord or pelvic injury (typically male urethral injury due to pelvic trauma), incontinence, vaginal prolapse, or in need of urinary diversion or bladder replacement surgery. I perform all of the complex bladder reconstructive procedures which use large or small intestine to build a continent urinary storage system that replaces the bladder. In these cases the bladder is most often removed secondary to cancer. I attend two full clinic days per week and one operative day per week. I perform an average of 10-12 minor procedures per scheduled day, which include prostate biopsy, vasectomy, cystoscopy, and circumcision. While performing the minor procedures listed above I simultaneously staff a General Urology Clinic of approximately 10-20 patients.

I am the responsible attending surgeon for a specialty that primarily consists of male urethral stricture disease, voiding dysfunction / female vaginal prolapse, and spinal cord injury clinics. These clinics routinely consist of 25-30 (this includes an average of five to seven new patients) patients per day. I see a monthly spinal cord clinic consisting of patients with neuropathic voiding dysfunction. Common diagnoses are traumatic and congenital spinal cord injury, Multiple Sclerosis, and Parkinson’s disease. I evaluate approximately 25 patients per scheduled clinic day (average of 3-5 new patients per scheduled Spinal Cord Clinic). In addition to my office days I read and report on 30 Urodynamic studies per month. Urodynamic studies involve placement of a pressure and volume monitoring catheter in the bladder, electrode needles in the urinary sphincter muscle system, and performing a 4 channel study measuring abdominal pressure, bladder pressure, volume, and electrical activity over time as a patient’s bladder is filled and again when they empty their bladder. Such studies are instrumental in diagnosing and caring for patients with voiding dysfunction, particularly those with neurologic disorders such as prior spinal cord injury.

My research efforts are mainly based upon the clinical outcomes. My more recent focus is on men receiving Proton therapy for prostate cancer. Reporting on this relatively new modality in collaboration with the Proton Center at UF has allowed for the publication of multiple topics. My main interest is the impact of Proton therapy on voiding function and sometimes dysfunction as well as the sexual side effects of such therapy. Prostate cancer is the most common cancer in men. Five-year survival, however, is 98% according to the National Institute of Health. All therapeutic interventions for prostate cancer carry risk and have some impact on a patient’s quality of life after treatment. Accurate publication of outcomes is the corner stone to becoming a credible resource for other institutions. The close relationship with physicians of the Proton Center, led by Dr. Nancy Mendenhall, is one of trust and complete confidence in the data reviewed. It has allowed for a productive series of publications describing the impact of therapy as well as side effects. The Proton Center is one of the most prestigious and highest volume centers in the nation. As such we have reported in 2014 on a review of the rise of systemic bacterial infections in men after biopsy or marker placement by the transrectal route. In 2016 we published further on the topic including ways to prevent significant post marker placement infection by first performing pre-procedure rectal cultures and specifically identifying resistant bacteria which would be cause for a change in antibiotic regimen. Post-procedural sepsis (systemic infection due to seeding of bacteria in the blood stream) carries the risk of serious morbidity and in some cases may result in death. The incidence of post prostate biopsy sepsis ranges from 0.67%-18% when reviewing multiple reports. Although most institutions do not experience double digit rates of sepsis, there is a consensus that the incidence is on the rise due to increasing resistance to fluoroquinolone antibiotics. Ciprofloxacin and Levofloxacin have been the main stay prophylactic antibiotics since the late 1980’s. The broad coverage of bacteria, ease of dosing orally, and excellent bioavailability make them ideal. The conclusions and specific recommendations made based upon clinical data from our review were: 1. Perform rectal culture and sensitivity tests prior to biopsy, 2. empirically change antibiotics when necessary and use the culture results to direct therapy, 3. Consider a transperineal rather than transrectal approach for biopsy or marker placement. In May of 2018 we published on the impact of pre-procedural rectal culture and sensitivity on our population of men. From 2015-2017 412 men were treated for prostate cancer in the Proton Center. Pre-procedural rectal cultures were obtained and directed antibiotic prophylaxis was performed for each procedure. The incidence of sepsis in our population was 0.2% Other quality of life outcome measures reported in regard to Proton therapy for prostate cancer are the negative impact of prior transurethral resection of the prostate on men’s quality of life after proton therapy when compared to a control group. Numerous publications have been made regarding the impact of proton on testosterone levels. I continue to follow and report on interventions for spinal cord injured patients suffering from neuropathic voiding dysfunction. One publication was of a novel approach to patients with bladder calculi and neuropathic voiding dysfunction. These patients often have large stones and are can have difficult surgical access due to prior injuries. Using careful imaging review these patients can be approached percutaneously which results in effective stone treatment and expedited recovery. I also was the principle investigator and first author on a study that was prospective randomized trial on catheter type and length preferences in men who empty their own bladder by self-catheterization. I will be meeting with a company that manufactures catheters and wants to perform a similar catheter preference study this week. This will also be a multi-institutional randomized study.