Miller School Urologists Work Alongside UM Engineers to Pioneer Urologic Innovation

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The Desai Sethi Urology Institute at the University of Miami Miller School of Medicine has taken an unprecedented step to recruit an engineer to work directly with the institute’s physicians and researchers to develop innovations, including a chip to replicate prostate cancer bone metastases and a 3-D bladder model complete with human-like neurons, for incontinence research.

Ashutosh Agarwal, Ph.D., associate professor of biomedical engineering at the University of Miami College of Engineering, will assume the new role of director for applied physics and engineering at the Desai Sethi Urology Institute.

Ashutosh Agarwal, Ph.D., will assume the new role of director for applied physics and engineering at the Desai Sethi Urology Institute.

Recent events led to the collaboration between urology and engineering, according to Dr. Agarwal.

The institute’s Professor and Chair and Director of Robotic Surgery Dipen J. Parekh, M.D., has encouraged more active research in the urology department and brought in increased surgical innovation.

The department got a big boost in late 2021 from the Desai Sethi Foundation with funding to create the Desai Sethi Urology Institute. One of the goals and benchmarks of success for the Desai Sethi Urology Institute is to have a highly active, internationally recognized and extramurally funded research group, according to Dr. Agarwal.

The funding has fueled new opportunities for research innovation in a technology-driven specialty, he said.

“Image-guided surgery and robots are among the engineering innovations that urologic surgeons already employ. I look forward to helping urologists take that and other innovations to the next level,” Dr. Agarwal said. “What’s so unique about this program is that engineers are fully embedded in the clinical program. There are no walls, no silos — clinicians can directly bring us not only clinical tissue but clinical understanding and relevance of what’s important and what’s not.”

Projects Underway

Dr. Agarwal has begun to explore three areas of urologic innovation with institute faculty.

The first is in collaboration with Dr. Parekh to address a need in prostate cancer patient care.

Dr. Agarwal leads a lab which creates technology that simulates lifelike human organs on computerized chips the size of a credit card. He and colleagues create human tissue-engineered environments on these chips to study human diseases or therapeutics.

“With Dr. Parekh, we will use this technology to better understand how prostate cancer metastasizes to bone. Even though we might be very good at treating prostate cancer, we’re not really good at stopping bone metastases. So, we are creating a patient’s bone environment and that patient’s prostate cancer on a chip to observe how the cancer goes to the bone to start bony metastases,” Dr. Agarwal said.

As a result of the research, clinicians could someday have better surveillance tools to prevent bone metastases in prostate cancer and better ways treat and manage it, according to Dr. Agarwal.

3-D Bioprinting

Another collaborative project of urology and engineering involves 3-D bioprinting. In this case, Dr. Agarwal is working alongside Raveen Syan, M.D., assistant professor of clinical urology at the Miller School.

“Dr. Syan brought us the idea of the need to better study the human bladder,” Dr. Agarwal said. “As a result, we are working to 3-D print a 3-D model of the entire bladder, along with the neurons inside it, to conduct research on the kinds of drugs that cause a neurologically malfunctioning bladder. Ultimately, this research is to prevent bladder malfunction or restore bladder function in patients.”

Using 3-D-created organs can result in research that better correlates to humans than animal studies, according to Dr. Agarwal, who creates these life-like environments using cells from human tissue that might have otherwise been discarded from autopsies or procedures.

Preserving Fertility

Dr. Agarwal is also collaborating with Ranjith Ramasamy, M.D., director of reproductive urology at the Miller School, to preserve male fertility in pediatric patients treated for certain cancers.

“Prepubertal male patients that have been treated for certain cancers with life-saving radiation therapy might in the process become infertile. That’s because the radiation therapy affects the growing testes in preadolescent boys,” Dr. Agarwal said.

These young patients face infertility later in life.

With patient and family consent, Dr. Ramasamy will take some of the patient’s testicular tissue before the patient undergoes radiation therapy.

“This is really exciting. In essence, we are creating  an environment in my chips to keep that human testicular tissue functional, with the ‘holy grail’ being the ability to create sperm years later,” Dr. Agarwal said.

Model Partnerships

The Desai Sethi Urology Institute’s partnership with engineering to advance urological care could be model for other academic urology departments and centers, according to Dr. Agarwal.

Clinical urology departments in the U.S. tend to be focused on clinically managing patients but don’t generally have the focus needed to engineer next-generation therapies.

“The only way to truly generate innovation is to bring a discipline like engineering into the mix. You need a department chair with the vision to do this and a donor who can fund this kind of collaboration. It comes down to thinking outside of the clinical box,” Dr. Agarwal said.