3D-Printing-Assisted Extraluminal Anti-Reflux Diodes for Preventing Vesicoureteral Reflux through Double-J Stents.

This paper presents novel umbrella-shaped flexible devices to prevent vesicoureteral reflux along double-J stents, which is a backward flow of urine from the bladder to the kidney and is a critical issue in patients with urinary stones. The anti-reflux devices were designed to mechanically attach to the stent and were manufactured using three-dimensional (3D) printing and polymer casting methods. Based on the umbrella shapes, four different devices were manufactured, and the anti-reflux efficiency was demonstrated through in vitro experiments using a urination model. Consequently, penta-shaped devices exhibited the best anti-reflux performance (44% decrease in reflux compared to the stent without the device), and maximum efficiency occurred when the device was attached near the bladder-ureter junction. In addition, a disadvantage of 3D printing (i.e., unwanted rough surface) helped the device strongly adhere to the surface of the stent during the insertion operation. Finally, long-term soaking experiments revealed that the fabricated devices were mechanically robust and chemically stable (safe) even being soaked in urine for 4 weeks. The findings of this study support the use of additive manufacturing to make various flexible and biocompatible urological devices to mitigate critical issues in patients with urinary stones.