Dynamic URP: Revisiting Urethral Retro-Resistance Pressure for Contemporary Sphincter-Targeted Therapy.

Area of Science:

• Urology
• Physiology
• Biomedical Engineering

Background:

• External urethral sphincter (EUS) function is critical for continence.
• Current diagnostic tools lack real-time feedback on EUS engagement during interventions.
• Renewed interest in EUS-targeted therapies necessitates novel assessment methods.

Purpose of the Study:

• To introduce a conceptual framework for interpreting urethral retro-resistance pressure (URP) as a dynamic, intra-procedural tool (ΔURP).
• To propose ΔURP as a functional biomarker for evaluating EUS engagement during injection therapies.
• To re-examine URP in the context of emerging EUS-targeted treatments.

Main Methods:

• Conceptual review of EUS anatomy, neurophysiology, and histology.
• Analysis of the historical use and decline of URP.
• Comparison of URP utility to conventional diagnostic tools.
• Definition and exploration of ΔURP (change in URP from baseline) as an objective measure.

Main Results:

• URP can be reframed as a dynamic, motion-based readout (ΔURP).
• ΔURP offers a physiologic signal of therapeutic engagement during EUS interventions.
• Conventional urodynamic measures do not isolate distal sphincter function, unlike URP.

Conclusions:

• ΔURP provides real-time functional feedback at the site of action for EUS therapies.
• This dynamic model has potential applications in guiding therapy, evaluating response, and standardizing outcomes.
• ΔURP can repurpose URP into a clinically actionable biomarker for next-generation continence care.