{"id":560665,"date":"2025-09-07T11:03:08","date_gmt":"2025-09-07T11:03:08","guid":{"rendered":"https:\/\/liveutifree.com\/leve-ao-seu-medico-luf\/"},"modified":"2025-10-23T13:54:47","modified_gmt":"2025-10-23T13:54:47","slug":"leve-ao-seu-medico-luf","status":"publish","type":"page","link":"https:\/\/liveutifree.com\/pt-br\/leve-ao-seu-medico-luf\/","title":{"rendered":"Leve ao seu m\u00e9dico"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div class=\"x-section e560665-e1 mc0m1-0\"><div class=\"x-row e560665-e2 mc0m1-1 mc0m1-2 mc0m1-3\"><div class=\"x-row-inner\"><div class=\"x-col e560665-e3 mc0m1-7 mc0m1-8\"><div class=\"x-text x-text-headline e560665-e4 mc0m1-9 mc0m1-a heading-02\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h1 class=\"x-text-content-text-primary\">Conversando com seu m\u00e9dico sobre ITU cr\u00f4nica<\/h1>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e5-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-div e560665-e6 mc0m1-f\"><div class=\"x-text x-content e560665-e7 mc0m1-g body-regular\">Etapa 1<\/div><a class=\"x-anchor x-anchor-button e560665-e8 mc0m1-i button-blue-primary\" tabindex=\"0\" href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\"><div class=\"x-anchor-content\"><div class=\"x-anchor-text\"><span class=\"x-anchor-text-primary\">Fa\u00e7a o download e compartilhe com seu m\u00e9dico (pdf)<\/span><\/div><\/div><\/a><hr class=\"x-line e560665-e9-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e10 mc0m1-g body-regular\">Etapa 2<\/div><a class=\"x-anchor x-anchor-button e560665-e11 mc0m1-i button-blue-primary\" tabindex=\"0\" href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2025\/03\/TTYD-Patient-Guidelines-1.pdf\"><div class=\"x-anchor-content\"><div class=\"x-anchor-text\"><span class=\"x-anchor-text-primary\">Fa\u00e7a o download para se preparar para sua consulta (pdf)<\/span><\/div><\/div><\/a><\/div><hr class=\"x-line e560665-e12-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e13 mc0m1-g mc0m1-h body-medium\">N\u00e3o importa se voc\u00ea \u00e9 novo no mundo dos sintomas persistentes do trato urin\u00e1rio inferior (LUTS) ou se j\u00e1 est\u00e1 lidando com eles h\u00e1 tempo suficiente para se considerar um especialista em pesquisa de ITUs em casa, voc\u00ea provavelmente j\u00e1 procurou informa\u00e7\u00f5es confi\u00e1veis para compartilhar com seu m\u00e9dico.<\/div><hr class=\"x-line e560665-e14-v0 mc0m1-c mc0m1-d\"\/><a class=\"x-image e560665-e15 mc0m1-j\" href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><img decoding=\"async\" src=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2023\/04\/TTYD-landing-page.png\" width=\"700\" height=\"700\" alt=\"Uma pilha de documentos intitulada Improving Treatment Pathways for Patients with Persistent Lower Urinary Tract Symptoms (Melhorando as vias de tratamento para pacientes com sintomas persistentes do trato urin\u00e1rio inferior), incluindo informa\u00e7\u00f5es sobre as op\u00e7\u00f5es de testes no Reino Unido e nos EUA e detalhes sobre a fun\u00e7\u00e3o do trato urin\u00e1rio inferior (LUF) para discutir com um m\u00e9dico.\" loading=\"lazy\"><\/a><hr class=\"x-line e560665-e16-v0 mc0m1-c mc0m1-d\"\/><div class=\"x-text x-content e560665-e17 mc0m1-g body-medium\"><p>Mas pode ser dif\u00edcil encontrar recursos de qualidade sobre esse t\u00f3pico. Por isso, desenvolvemos materiais que fornecem informa\u00e7\u00f5es pr\u00e1ticas e incentivam a discuss\u00e3o entre voc\u00ea e seu m\u00e9dico. Por meio das ferramentas listadas acima, voc\u00ea pode acessar  <span> <\/span><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\"><span style=\"text-decoration: underline;\">pesquisa baseada em evid\u00eancias (pdf)<\/span><\/a><span> <\/span>para voc\u00ea compartilhar com seu m\u00e9dico, e um<span> <\/span><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2025\/03\/TTYD-Patient-Guidelines-1.pdf\"><span style=\"text-decoration: underline;\">guia (pdf)<\/span><\/a><span> <\/span>para incentivar a comunica\u00e7\u00e3o.<\/p>\n<p>\u00c9 importante que todas as informa\u00e7\u00f5es compartilhadas com m\u00e9dicos ocupados sejam baseadas em pesquisas revisadas por pares e de leitura r\u00e1pida.<\/p>\n<p>Levamos tudo isso em considera\u00e7\u00e3o ao desenvolver os materiais \"Leve ao seu m\u00e9dico\". Escrito em parceria com nossos consultores m\u00e9dicos e de pesquisa, coletamos e resumimos alguns dos estudos mais impactantes sobre ITU e os apresentamos em um formato f\u00e1cil de navegar. <\/p><\/div><\/div><\/div><\/div><hr class=\"x-line e560665-e18-v0 mc0m1-c mc0m1-e\"\/><div class=\"x-row e560665-e19 mc0m1-1 mc0m1-2 mc0m1-4\"><div class=\"x-row-inner\"><div class=\"x-col e560665-e20 mc0m1-7 mc0m1-8\"><div class=\"x-text x-text-headline e560665-e21 mc0m1-9 heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Como come\u00e7ar<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e22-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e23 mc0m1-g body-medium\"><ol>\n \t<li><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2024\/04\/2024-Improving-Treatment-Pathways-for-Patients-with-Lower-Urinary-Tract-Symptoms.pdf\"><span style=\"text-decoration: underline;\">Fa\u00e7a o download do recurso cl\u00ednico (pdf)<\/span><\/a><\/li>\n \t<li><a href=\"https:\/\/liveutifree.com\/wp-content\/uploads\/2025\/03\/TTYD-Patient-Guidelines-1.pdf\"><span style=\"text-decoration: underline;\">Fa\u00e7a o download do guia do paciente para compartilhar esses recursos com seu m\u00e9dico (pdf)<\/span><\/a><\/li>\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=PRZEYZ6ctuY\" target=\"_blank\" rel=\"noopener\"><span style=\"text-decoration: underline;\">Assista ao recurso cl\u00ednico Entendendo a ITU<\/span><\/a><\/li>\n \t<li><a href=\"https:\/\/www.youtube.com\/watch?v=VcUGOUjuEXY\" target=\"_blank\" rel=\"noopener\"><span style=\"text-decoration: underline;\">Assista a Como usar o guia do paciente e a planilha<\/span><\/a><\/li>\n<\/ol><\/div><hr class=\"x-line e560665-e24-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e25 mc0m1-g body-medium\"><p>Agradecemos por voc\u00ea ter um papel ativo na educa\u00e7\u00e3o de outras pessoas sobre ITUs persistentes e de dif\u00edcil diagn\u00f3stico e gostar\u00edamos de ouvir sobre sua experi\u00eancia com esses recursos. Voc\u00ea pode <span> <\/span><span style=\"color: #c74f4d;\"><a href=\"https:\/\/liveutifree.com\/pt-br\/contato-luf\/\" style=\"color: #c74f4d;\"><span style=\"text-decoration: underline;\">Entre em contato conosco diretamente<\/span><\/a><\/span>.<\/p>\n<p>Se voc\u00ea achou essas informa\u00e7\u00f5es \u00fateis, pode apoiar os esfor\u00e7os de educa\u00e7\u00e3o adicional e outros projetos<span> <\/span><a href=\"https:\/\/liveutifree.com\/pt-br\/contribua-com-a-luf\/\"><span style=\"text-decoration: underline;\">contribuindo para o trabalho que mais significa para voc\u00ea<\/span><\/a><span style=\"color: #800000;\">.<\/span><\/p><\/div><hr class=\"x-line e560665-e26-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-text-headline e560665-e27 mc0m1-9 mc0m1-a heading-04\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><p class=\"x-text-content-text-primary\">Trechos de Improving Treatment Pathways for Patients with Persistent Lower Urinary Tract Symptoms (Melhorando as vias de tratamento para pacientes com sintomas persistentes do trato urin\u00e1rio inferior)<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><hr class=\"x-line e560665-e28-v0 mc0m1-c mc0m1-e\"\/><div class=\"x-row e560665-e29 mc0m1-1 mc0m1-2 mc0m1-5\"><div class=\"x-row-inner\"><div class=\"x-col e560665-e30 mc0m1-7 mc0m1-8\"><div class=\"x-text x-text-headline e560665-e31 mc0m1-9 mc0m1-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Entendendo a conex\u00e3o do microbioma vaginal e urin\u00e1rio<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e32-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e33 mc0m1-g body-medium\"><ul>\n \t<li>Embora os microbiomas do trato urin\u00e1rio e da bexiga sejam \u00fanicos, h\u00e1 uma sobreposi\u00e7\u00e3o significativa entre as esp\u00e9cies e as fun\u00e7\u00f5es proteicas dos dois ambientes, o que d\u00e1 margem \u00e0 teoria de que eles poderiam ser considerados um \u00fanico microbioma urogenital<sup>.5<\/sup><\/li>\n \t<li>Em mulheres com disbiose vaginal, existe um risco maior de desenvolver uma ITU em compara\u00e7\u00e3o com mulheres com um microbioma vaginal dominado por<span> <\/span> Lactobacillus<sup>.37<\/sup><\/li>\n<\/ul><\/div><hr class=\"x-line e560665-e34-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e35 mc0m1-g body-medium\"><span>75%, 46% e 13% das mulheres com vaginose bacteriana, candid\u00edase ou tricomon\u00edase, respectivamente, tamb\u00e9m t\u00eam uma ITU.<\/span><sup>38<\/sup><\/div><hr class=\"x-line e560665-e36-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-text-headline e560665-e37 mc0m1-9 mc0m1-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Pesquisa atual sobre o microbioma da bexiga<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e38-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e39 mc0m1-g body-medium\"><ul>\n \t<li>As comunidades bacterianas foram observadas em 80% das amostras obtidas por cateter transuretral de participantes do sexo feminino, com at\u00e9 92% das amostras sendo relatadas como \"sem crescimento\" usando o SUC<sup>.1<\/sup><span> <\/span>Uma disbiose desse microbioma urin\u00e1rio saud\u00e1vel (o urobioma) est\u00e1 correlacionada com o desenvolvimento de sintomas e dist\u00farbios urin\u00e1rios<sup>.1-3<\/sup><\/li>\n \t<li>Os participantes com sintomas urin\u00e1rios demonstraram um urobioma mais diversificado, com maior quantidade de bact\u00e9rias do que os controles assintom\u00e1ticos. A frequ\u00eancia de detec\u00e7\u00e3o bacteriana foi de 81% a 86% para coortes sintom\u00e1ticas, em compara\u00e7\u00e3o com apenas 57% na coorte de controle. <em><sup>1,2,4,5<\/sup><\/em><\/li>\n \t<li>Quando comparados com controles assintom\u00e1ticos, os pacientes com incontin\u00eancia de urg\u00eancia apresentaram diferen\u00e7as estatisticamente significativas em seu urobioma, com n\u00edveis mais baixos de<span> <\/span> Lactobacillus<em><span> <\/span> e n\u00edveis mais altos de<\/em><span> <\/span><em>Gardnerella<\/em><sup>.6,7,8<\/sup><\/li>\n<\/ul><\/div><hr class=\"x-line e560665-e40-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-text-headline e560665-e41 mc0m1-9 mc0m1-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Evid\u00eancia de infec\u00e7\u00e3o polimicrobiana<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e42-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e43 mc0m1-g body-medium\"><ul>\n \t<li>Os recursos limitados e<span> <\/span>O vi\u00e9s <em>centrado em E. coli<\/em> da cultura de urina padr\u00e3o (SUC) foi bem estabelecido. A SUC identifica apenas 24% dos casos que n\u00e3o s\u00e3o de E<em>. coli<\/em> <span> <\/span>uropatog\u00eanicos, e surgiram evid\u00eancias de infec\u00e7\u00e3o polimicrobiana. Price et al. usaram a cultura de urina quantitativa expandida (EQUC) para examinar infec\u00e7\u00f5es polimicrobianas. 81% das amostras que detectaram  <span> <\/span><em>E. coli<\/em><span> <\/span>tamb\u00e9m continha pelo menos um pat\u00f3geno adicional<sup>.11<\/sup><\/li>\n \t<li>Vollstedt et al. utilizaram a rea\u00e7\u00e3o em cadeia da polimerase (PCR). Dos 1.352 esp\u00e9cimes que deram positivo para bact\u00e9rias, 56,1% foram relatados como sendo polimicrobianos. Embora nem todos os organismos de uma amostra sejam necessariamente patog\u00eanicos, a possibilidade de uma infec\u00e7\u00e3o polimicrobiana deve ser considerada em pacientes sintom\u00e1ticos<sup>.24<\/sup>  <\/li>\n \t<li>Quando as limita\u00e7\u00f5es do SUC s\u00e3o removidas, surge a oportunidade de uma tomada de decis\u00e3o mais informada. As intera\u00e7\u00f5es entre os organismos presentes no urobioma de um indiv\u00edduo devem ser consideradas, pois afetam os resultados relatados pelo paciente<sup>.7,12,25<\/sup> <\/li>\n<\/ul><\/div><hr class=\"x-line e560665-e44-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-text-headline e560665-e45 mc0m1-9 mc0m1-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Sintomas de uma ITU persistente<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e46-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e47 mc0m1-g body-medium\"><ul>\n \t<li>Os participantes do estudo com incontin\u00eancia de urg\u00eancia urin\u00e1ria (IUU) t\u00eam mais diversidade de urobioma do que os controles sem IUU<sup>.4,7<\/sup><span> <\/span>Quando os sintomas do trato urin\u00e1rio inferior est\u00e3o presentes, a considera\u00e7\u00e3o da microbiota exclusiva do paciente e o exame de microscopia podem ter um impacto positivo nos resultados do tratamento.<\/li>\n \t<li>Um estudo prospectivo e duplo-cego realizado por Warren et al. demonstrou que 48% dos participantes diagnosticados com CI que foram submetidos a tratamento com antibi\u00f3ticos por 18 semanas relataram uma redu\u00e7\u00e3o na urg\u00eancia e na dor ou uma melhora geral nos sintomas, em compara\u00e7\u00e3o com 24% dos participantes do grupo placebo. Embora sejam necess\u00e1rios mais estudos, esse resultado sugere que os pacientes com complexos de sintomas urin\u00e1rios podem ter uma ITU n\u00e3o diagnosticada<sup>.6,27<\/sup> <\/li>\n<\/ul><\/div><hr class=\"x-line e560665-e48-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-text-headline e560665-e49 mc0m1-9 mc0m1-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Como o biofilme contribui para aproximadamente 80% das infec\u00e7\u00f5es recorrentes<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e50-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e51 mc0m1-g body-medium\"><ul>\n \t<li><strong>Taxa de recorr\u00eancia:<span> <\/span><\/strong>Ap\u00f3s o in\u00edcio de uma ITU aguda, o risco de recorr\u00eancia futura aumenta. De 19 a 24% das mulheres ter\u00e3o uma ITU recorrente dentro de 6 meses ap\u00f3s a primeira infec\u00e7\u00e3o e, para aquelas pacientes com hist\u00f3rico de ITUs, 70% ter\u00e3o uma recorr\u00eancia dentro de um ano<sup>.10,29<\/sup> <span> <\/span>V\u00e1rios fatores discutidos anteriormente, como o vi\u00e9s da cultura de urina padr\u00e3o (SUC) e as limita\u00e7\u00f5es do relat\u00f3rio de sensibilidade, contribuem para o aumento das taxas de recorr\u00eancia. Entretanto, a presen\u00e7a de biofilme desempenha um papel importante. <\/li>\n \t<li>Biofilmes <strong>bacterianos:<\/strong><span> <\/span>Os biofilmes s\u00e3o comunidades bacterianas envoltas em uma matriz de polissacar\u00eddeos capazes de aderir a superf\u00edcies e tecidos e dentro deles, expressando genes de resist\u00eancia a antibi\u00f3ticos e influenciando muito o desenvolvimento de infec\u00e7\u00f5es cr\u00f4nicas<sup>.28<\/sup><span> <\/span> A E<em>. coli<span> <\/span><\/em>\u00e9 especificamente uma bact\u00e9ria com alta produ\u00e7\u00e3o de biofilme, respons\u00e1vel por contribuir para infec\u00e7\u00f5es cr\u00f4nicas e recorrentes, sendo que 62,5% das infec\u00e7\u00f5es por<span> <\/span> E<em>. coli<\/em><span> <\/span>demonstraram produzir biofilme<sup>.6,30,31<\/sup><\/li>\n \t<li><strong>Preval\u00eancia:<span> <\/span><\/strong>Quando comparados com controles assintom\u00e1ticos, 75% dos pacientes com sintomas do trato urin\u00e1rio inferior (LUTS) tinham evid\u00eancias de IBCs, em compara\u00e7\u00e3o com 17% encontrados em controles, indicando o poss\u00edvel papel do biofilme nos sintomas urin\u00e1rios<sup>.6<\/sup><span> <\/span>Conforme explicado por Scott et al.,<span> <\/span><em>\"os IBCs podem ter um papel n\u00e3o apenas na etiologia da ITU recorrente, mas tamb\u00e9m dos LUTS cr\u00f4nicos experimentados por algumas mulheres que recebem o diagn\u00f3stico de OAB ou IC\/BPS\".<\/em><em><sup>6<\/sup><\/em><\/li>\n \t<li><strong>Outras infec\u00e7\u00f5es associadas a biofilmes:<\/strong><span> <\/span>Biofilmes e IBCs s\u00e3o reconhecidos como associados a outras infec\u00e7\u00f5es teciduais, como infec\u00e7\u00f5es dent\u00e1rias, infec\u00e7\u00f5es do trato respirat\u00f3rio, endocardite, prostatite e outras<sup>.28<\/sup><\/li>\n<\/ul><\/div><\/div><\/div><\/div><hr class=\"x-line e560665-e52-v0 mc0m1-c mc0m1-e\"\/><div class=\"x-row e560665-e53 mc0m1-1 mc0m1-2 mc0m1-6\"><div class=\"x-row-inner\"><div class=\"x-col e560665-e54 mc0m1-8\"><div class=\"x-text x-text-headline e560665-e55 mc0m1-9 mc0m1-a heading-03\"><div class=\"x-text-content\"><div class=\"x-text-content-text\"><h3 class=\"x-text-content-text-primary\">Refer\u00eancias<\/h3>\n<\/div><\/div><\/div><hr class=\"x-line e560665-e56-v0 mc0m1-b mc0m1-c\"\/><div class=\"x-text x-content e560665-e57 mc0m1-g body-medium\"><ol>\n \t<li>Hilt EE, Mckinley K, Pearce MM, et al. Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder (A urina n\u00e3o \u00e9 est\u00e9ril: uso de t\u00e9cnicas aprimoradas de cultura de urina para detectar a flora bacteriana residente na bexiga feminina adulta). <span> <\/span><em>Journal of Clinical Microbiology<\/em>. 2013;52(3):871-876. doi:  <span> <\/span><span style=\"text-decoration: underline; color: #c74f4d;\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24371246\/\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: #c74f4d; text-decoration: underline;\">10.1128\/jcm.02876-13<\/a><\/span><\/li>\n \t<li>Wolfe A, Toh E, Shibata N et al. Evidence of Uncultivated Bacteria in the Adult Female Bladder (Evid\u00eancia de bact\u00e9rias n\u00e3o cultivadas na bexiga feminina adulta). <span> <\/span><em>J Clin Microbiol<\/em>. 2012;50(4):1376-1383. doi:  <span> <\/span><span style=\"text-decoration: underline; color: #c74f4d;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3318548\/\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: #c74f4d; text-decoration: underline;\">10.1128\/jcm.05852-11<\/a><\/span><\/li>\n \t<li>Thomas-White K, Brady M, Wolfe AJ, Mueller ER. 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