Fleischmann Nicole
White Plains Hospital Center, New York, NY 10601, USA.
Diagnostics (Basel). 2025 Jul 23;15(15):1855. doi: 10.3390/diagnostics15151855.
This paper introduces a new conceptual framework for interpreting urethral retro-resistance pressure (URP) as a dynamic, intra-procedural tool-ΔURP-for evaluating external urethral sphincter (EUS) engagement during injection therapy. With renewed interest in therapies that directly target the EUS, there is a critical need for real-time functional feedback at the site of action. This conceptual review re-examines URP in the context of emerging EUS-targeted treatments-such as bulking agents, regenerative injections, and neuromodulatory interventions-and proposes a dynamic model (ΔURP) to measure changes in sphincteric resistance as a functional biomarker during intervention. We review the anatomical, neurophysiological, and histological features of the EUS complex; trace the clinical rise and decline of URP; and compare its utility to conventional diagnostic tools. ΔURP, defined as the change in URP from baseline, is explored as an objective measure of EUS function. We outline its potential applications in guiding therapy, evaluating response, and standardizing outcomes across treatments. Conventional urodynamic measures fail to isolate distal sphincter function. In contrast, URP directly challenges the EUS and, when combined with imaging or procedural tools, may provide real-time feedback on sphincter engagement. When reframed as a dynamic, motion-based readout, URP may fill a critical gap in procedural urology-offering a physiologic signal of therapeutic engagement during EUS-targeted interventions. ΔURP has the potential to revive and repurpose a once-abandoned method into a clinically actionable biomarker for next-generation continence care.
本文介绍了一种新的概念框架，将尿道逆行阻力压力（URP）解释为一种动态的术中工具——ΔURP，用于评估注射治疗期间外尿道括约肌（EUS）的参与情况。随着对直接针对EUS的治疗方法的兴趣重新燃起，在作用部位进行实时功能反馈的需求至关重要。这篇概念性综述在新兴的以EUS为靶点的治疗方法（如填充剂、再生注射和神经调节干预）的背景下重新审视了URP，并提出了一个动态模型（ΔURP），以测量括约肌阻力的变化，作为干预期间的功能生物标志物。我们回顾了EUS复合体的解剖学、神经生理学和组织学特征；追溯了URP的临床兴起和衰落；并将其效用与传统诊断工具进行了比较。ΔURP被定义为URP相对于基线的变化，被探索为EUS功能的客观测量指标。我们概述了其在指导治疗、评估反应和标准化不同治疗结果方面的潜在应用。传统的尿动力学测量方法无法分离远端括约肌功能。相比之下，URP直接挑战EUS，并且当与成像或手术工具结合使用时，可能提供关于括约肌参与情况的实时反馈。当被重新构建为基于动态运动的读数时，URP可能填补程序性泌尿外科的一个关键空白——在以EUS为靶点的干预期间提供治疗参与的生理信号。ΔURP有可能将一种曾经被弃用的方法重新启用并重新定位，使其成为下一代尿失禁护理中具有临床可操作性的生物标志物。
