The potential of 3D printing in urological research and patient care

Key Points

  • 3D printing is a technology that has been used in manufacturing for a few decades and multiple medical fields have adopted this technology for the creation of both inorganic and organic constructs

  • Inkjet printing, extrusion printing, laser sintering, and stereolithography, each with its own advantages and disadvantages, are the four major techniques used for 3D printing

  • 3D printers were previously expensive, but new models can now be purchased from US$300; the printing times can be highly variable depending on the desired resolution of the construct

  • In urology, 3D printing is currently being applied to create implantable devices such as ureteral stents, as well as inorganic models for surgical planning

  • Animal studies are already underway for the creation of 3D organic constructs that are intended to replace vital organs, including the bladder, kidneys, and urethra

  • The goal of bioprinting 3D organic constructs is to provide a personalized solution for organ replacement, alleviating the shortage of suitable transplant organs and associated complications

Abstract

3D printing is an evolving technology that enables the creation of unique organic and inorganic structures with high precision. In urology, the technology has demonstrated potential uses in both patient and clinician education as well as in clinical practice. The four major techniques used for 3D printing are inkjet printing, extrusion printing, laser sintering, and stereolithography. Each of these techniques can be applied to the production of models for education and surgical planning, prosthetic construction, and tissue bioengineering. Bioengineering is potentially the most important application of 3D printing, as the ability to produce functional organic constructs might, in the future, enable urologists to replicate and replace abnormal tissues with neo-organs, improving patient survival and quality of life.

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Figure 1: 3D printing techniques.
Figure 2: 3D-printed models for training and education.
Figure 3: 3D printing of a kidney scaffold.

References

  1. 1

    Ford, H. & Crowther, S. My life and work. (Doubleday, 1923).

    Google Scholar 

  2. 2

    Hull, C. W. Apparatus for production of three-dimensional objects by stereolithography. US Patent 4575330 (1986).

  3. 3

    Myung, D., Jais, A., He, L., Blumenkranz, M. S. & Chang, R. T. 3D printed smartphone indirect lens adapter for rapid, high quality retinal imaging. J. Mob. Technol. Med. 3, 9–15 (2014).

    Article  Google Scholar 

  4. 4

    Otsuki, B. et al. Developing a novel custom cutting guide for curved peri-acetabular osteotomy. Int. Orthop. 37, 1033–1038 (2013).

    Article  Google Scholar 

  5. 5

    Alberti, C. Three-dimensional CT and structure models. Br. J. Radiol. 53, 261–262 (1980).

    CAS  Article  Google Scholar 

  6. 6

    Aldinger, G., Fischer, A. & Kurtz, B. Computer-aided manufacture of individual endoprostheses. Preliminary communication. Arch. Orthop. Trauma. Surg. 102, 31–35 (1983).

    CAS  Article  Google Scholar 

  7. 7

    Atalay, H. A. et al. Impact of three-dimensional-printed pelvicalyceal system models on residents' understanding of pelvicalyceal system anatomy before percutaneous nephrolithotripsy surgery: a pilot study. J. Endourol. 30, 1132–1137 (2016).

    Article  Google Scholar 

  8. 8

    Salmi, M. Possibilities of preoperative medical models made by 3D printing or additive manufacturing. J. Med. Eng. 2016, 6191526 (2016).

    Article  Google Scholar 

  9. 9

    Skardal, A. & Atala, A. Biomaterials for integration with 3D bioprinting. Ann. Biomed. Eng. 43, 730–746 (2015).

    Article  Google Scholar 

  10. 10

    Murphy, S. V. & Atala, A. 3D bioprinting of tissues and organs. Nat. Biotechnol. 32, 773–785 (2014).

    CAS  Article  Google Scholar 

  11. 11

    Guillotin, B. & Guillemot, F. Cell patterning technologies for organotypic tissue fabrication. Trends Biotechnol. 29, 183–190 (2011).

    CAS  Article  Google Scholar 

  12. 12

    Hölzl, K. et al. Bioink properties before, during and after 3D bioprinting. Biofabrication 8, 032002 (2016).

    Article  Google Scholar 

  13. 13

    Xu, T. et al. Viability and electrophysiology of neural cell structures generated by the inkjet printing method. Biomaterials 27, 3580–3588 (2006).

    CAS  PubMed  Google Scholar 

  14. 14

    Goldstein, T. A. et al. Feasibility of bioprinting with a modified desktop 3D printer. Tissue Eng. Part C Methods 22, 1071–1076 (2016).

    CAS  Article  Google Scholar 

  15. 15

    Graham, A. D. et al. High-resolution patterned cellular constructs by droplet-based 3D printing. Sci. Rep. 7, 70441 (2017).

    Google Scholar 

  16. 16

    Tekin, E., Smith, P. J. & Schubert, U. S. Inkjet printing as a deposition and patterning tool for polymers and inorganic particles. Soft Matter 4, 703–713 (2008).

    CAS  Article  Google Scholar 

  17. 17

    Fang, Y. et al. Rapid generation of multiplexed cell cocultures using acoustic droplet ejection followed by aqueous two-phase exclusion patterning. Tissue Eng. Part C Methods 18, 647–657 (2012).

    CAS  Article  Google Scholar 

  18. 18

    Phillippi, J. A. et al. Microenvironments engineered by inkjet bioprinting spatially direct adult stem cells toward muscle- and bone-like subpopulations. Stem Cells 26, 127–134 (2008).

    CAS  Article  Google Scholar 

  19. 19

    Campbell, P. G., Miller, E. D., Fisher, G. W., Walker, L. M. & Weiss, L. E. Engineered spatial patterns of FGF-2 immobilized on fibrin direct cell organization. Biomaterials 26, 6762–6770 (2005).

    CAS  Article  Google Scholar 

  20. 20

    Saunders, R. E., Gough, J. E. & Derby, B. Delivery of human fibroblast cells by piezoelectric drop-on-demand inkjet printing. Biomaterials 29, 193–203 (2008).

    CAS  Article  Google Scholar 

  21. 21

    Chang, C. C., Boland, E. D., Williams, S. K. & Hoying, J. B. Direct-write bioprinting three-dimensional biohybrid systems for future regenerative therapies. J. Biomed. Mater. Res. B Appl. Biomater. 98, 160–170 (2011).

    Article  Google Scholar 

  22. 22

    Jakab, K., Damon, B., Neagu, A., Kachurin, A. & Forgacs, G. Three-dimensional tissue constructs built by bioprinting. Biorheology 43, 509–513 (2006).

    PubMed  Google Scholar 

  23. 23

    Chang, R., Nam, J. & Sun, W. Effects of dispensing pressure and nozzle diameter on cell survival from solid freeform fabrication-based direct cell writing. Tissue Eng. Part A 14, 41–48 (2008).

    CAS  Article  Google Scholar 

  24. 24

    Colina, M., Serra, P., Fernández-Pradas, J. M., Sevilla, L. & Morenza, J. L. DNA deposition through laser induced forward transfer. Biosens. Bioelectron. 20, 1638–1642 (2005).

    CAS  Article  Google Scholar 

  25. 25

    Dinca, V. et al. Directed three-dimensional patterning of self-assembled peptide fibrils. Nano Lett. 8, 538–543 (2008).

    CAS  Article  Google Scholar 

  26. 26

    Lin, H. et al. Application of visible light-based projection stereolithography for live cell-scaffold fabrication with designed architecture. Biomaterials 34, 331–339 (2013).

    CAS  Article  Google Scholar 

  27. 27

    Smith, S. J., Bosniak, M. A., Megibow, A. J., Hulnick, D. H., Horii, S. C. & Raghavendra, B. N. Renal cell carcinoma: earlier discovery and increased detection. Radiology 170, 699–703 (1989).

    CAS  Article  Google Scholar 

  28. 28

    Srougi, V. et al. The use of three-dimensional printers for partial adrenalectomy: estimating the resection limits. Urology 90, 217–220 (2016).

    Article  Google Scholar 

  29. 29

    von Rundstedt, F.-C., Scovell, J. M., Agrawal, S., Zaneveld, J. & Link, R. E. Utility of patient-specific silicone renal models for planning and rehearsal of complex tumour resections prior to robot-assisted laparoscopic partial nephrectomy. BJU Int. 119, 598–604 (2017).

    CAS  Article  Google Scholar 

  30. 30

    Komai, Y. et al. Patient-specific 3-dimensional printed kidney designed for 4D surgical navigation: a novel aid to facilitate minimally invasive off-clamp partial nephrectomy in complex tumor cases. Urology 91, 226–232 (2016).

    Article  Google Scholar 

  31. 31

    Shin, T., Ukimura, O. & Gill, I. S. Three-dimensional printed model of prostate anatomy and targeted biopsy-proven index tumor to facilitate nerve-sparing prostatectomy. Eur. Urol. 69, 377–379 (2016).

    Article  Google Scholar 

  32. 32

    Knoedler, M. et al. Individualized physical 3-dimensional kidney tumor models constructed from 3-dimensional printers result in improved trainee anatomic understanding. Urology 85, 1257–1261 (2015).

    Article  Google Scholar 

  33. 33

    Bernhard, J. C. et al. Personalized 3D printed model of kidney and tumor anatomy: a useful tool for patient education. World J. Urol. 34, 337–345 (2016).

    Article  Google Scholar 

  34. 34

    Smektala, T., Golab, A., Królikowski, M. & Slojewski, M. Low cost silicone renal replicas for surgical training - technical note. Arch. Esp. Urol. 69, 434–436 (2016).

    CAS  PubMed  Google Scholar 

  35. 35

    Bücking, T. M. et al. From medical imaging data to 3D printed anatomical models. PLOS One 12, e0178540 (2017).

    Article  Google Scholar 

  36. 36

    Ebert, J. et al. Direct inkjet printing of dental prostheses made of zirconia. J. Dent. Res. 88, 673–676 (2009).

    CAS  Article  Google Scholar 

  37. 37

    Li, J., Hsu, Y., Luo, E., Khadka, A. & Hu, J. Computer-aided design and manufacturing and rapid prototyped nanoscale hydroxyapatite/polyamide (n-HA/PA) construction for condylar defect caused by mandibular angle ostectomy. Aesthet. Plast. Surg. 35, 636–640 (2011).

    CAS  Article  Google Scholar 

  38. 38

    Turgut, G., Sacak, B., Kiran, K. & Bas, L. Use of rapid prototyping in prosthetic auricular restoration. J. Craniofac. Surg. 20, 321–325 (2009).

    Article  Google Scholar 

  39. 39

    Lu, S. et al. A novel computer-assisted drill guide template for lumbar pedicle screw placement: a cadaveric and clinical study. Int. J. Med. Robot. 5, 184–191 (2009).

    Article  Google Scholar 

  40. 40

    Park, C.-J. et al. Anti-Reflux Ureteral Stent with Polymeric Flap Valve Using Three-Dimensional Printing: An In Vitro Study. J. Endourol. 29, 1–6 (2015).

    Article  Google Scholar 

  41. 41

    del Junco, M. et al. Development and initial porcine and cadaver experience with three-dimensional printing of endoscopic and laparoscopic equipment. J. Endourol. 29, 58–62 (2015).

    Article  Google Scholar 

  42. 42

    Neches, R. Y., Flynn, K. J., Zaman, L., Tung, E. & Pudlo, N. On the intrinsic sterility of 3D printing. PeerJ 4, e2661 (2016).

    Article  Google Scholar 

  43. 43

    Rankin, T. M. et al. 3D printing surgical instruments: are we there yet? J. Surg. Res. 189, 193–197 (2014).

    Article  Google Scholar 

  44. 44

    Colaco, M. & Atala, A. in The Future of Transplant Surgery and Biology Ch. 12.12 (Decker Publishing, 2014).

    Google Scholar 

  45. 45

    Spiller, K. L., Maher, S. A. & Lowman, A. M. Hydrogels for the repair of articular cartilage defects. Tissue Eng. Part B Rev. 17, 281–299 (2011).

    CAS  Article  Google Scholar 

  46. 46

    Li, Z. & Kawashita, M. Current progress in inorganic artificial biomaterials. J. Artif. Organs 14, 163–170 (2011).

    CAS  Article  Google Scholar 

  47. 47

    Zhang, K. et al. 3D bioprinting of urethra with PCL/PLCL blend and dual autologous cells in fibrin hydrogel: an in vitro evaluation of biomimetic mechanical property and cell growth environment. Acta Biomater. 50, 154–164 (2017).

    CAS  Article  Google Scholar 

  48. 48

    US National Library of Medicine. ClinicalTrials.gov. Safety and efficacy study of autologous engineered skin substitute to treat partial- and full-thickness burn wounds. https://clinicaltrials.gov/ct2/show/NCT01655407. (2016).

  49. 49

    Raya-Rivera, A. et al. Tissue-engineered autologous urethras for patients who need reconstruction: an observational study. Lancet 377, 1175–1182 (2011).

    Article  Google Scholar 

  50. 50

    Raya-Rivera, A. M. et al. Tissue-engineered autologous vaginal organs in patients: a pilot cohort study. Lancet 384, 329–336 (2014).

    Article  Google Scholar 

  51. 51

    Kang, H.-W. et al. A 3D bioprinting system to produce human-scale tissue constructs with structural integrity. Nat. Biotechnol. 34, 312–319 (2016).

    CAS  Article  Google Scholar 

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All authors researched data for the article, made substantial contributions to discussion of the article content, wrote, and reviewed and/or edited the manuscript before submission.

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Correspondence to Marc Colaco.

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Colaco, M., Igel, D. & Atala, A. The potential of 3D printing in urological research and patient care. Nat Rev Urol 15, 213–221 (2018). https://doi.org/10.1038/nrurol.2018.6

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