Vol. 11, No 1, 2004 pp. 5 - 10
UC 616-006:[611.61/62:616.61[497 11 Kolubara] 
URINARY TRACT TUMORS IN KOLUBARA REGION
Danica Bukvić1, Slavenka Janković2, Ljubica Djukanović3
1Institute of Endemic Nephropathy, Lazarevac
 E-mail: dana@absolutok.net
2Institute of Epidemiology, School of Medicine, Belgrade
3Institute of Urology and Nephrology, School of Medicine, Belgrade, Serbia
Summary. High incidence of the upper urothelial tumors in the endemic nephropathy regions was described in the very beginning of the disease investigations. In Kolubara region upper urothelial and bladder tumors appeared only in Lazarevac and Lajkovac municipalities, the most frequently in three villages most affected by endemic nephropathy: Petka, Šopić and Cvetovac. Urothelial tumors affected more frequently females than males (1.4:1) aged between 50 and 80 years, the most frequently persons in the seventh decade of life. Agriculture was the main or additional occupation of patients with tumors.
Etiology of the upper urothelial tumors is still unknown. Our study on the possible risk factors for the occurrence of these tumors indicated  smoking, positive family history of endemic nephropathy in second and third degree relation, presence of the affected with other malignant tumors in the first degree of relation, agriculture as occupation, urinary tract infection and some kind of food as the factors of influence.
According to our results 82% of the upper urothelial tumors were localized in the renal pelvis or ureters, while simultaneous appearance of tumors in the pelvis and ureter was less frequent (18%). The tumors appeared more frequently unilaterally than bilaterally (82% vs. 18%). Bladder tumors were registered in 18% of our patients.
Although endemic nephropathy often precedes the appearance of the upper urothelial tumors, our investigations in Lazarevac endemic foci also revealed the patients with upper urothelial tumors appearing before clinical manifestation of endemic nephropathy. Besides, upper urothelial tumors were registered in 29.8% of patients with endemic nephropathy maintained by hemodialysis in Lazarevac.
Key words: Upper urothelial tumors, endemic nephropathy, Kolubara region
TUMORI  MOKRAĆNIH PUTEVA U PODRUČJU KOLUBARE
Kratak sadržaj: Visoka incidencija tumora gornjeg urotelijuma u žarištima endemske nefropatije opisana je već posle prvih istraživanja ove bolesti. U području Kolubare tumori gornjeg urotelijuma i mokraćne bešike registroavani su u opštinama Lazarevac i Lajkovac, a najčešće u selima Petka, Šopić i Cvetovac koja su najugroženija endemskom nefropatijom. Tumori urotelijuma se u ovom području  češće javaljaju kod žena nego kod muškaraca (1,4:1) starosti od 50 do 80 godina, a najčešće i sedmoj deceniji života. Zemljoradnja je glavno ili dodatno zanimanje bolesnika sa tumorima.
Etiologija tumora gornjeg urotelijuma je još uvek nepoznata. Naša istraživanja faktora rizika za nastanak tumora urotelijuma su pokazala da su od značaja  pušenje, pozitivna porodična anamneza o endemskoj nefropatiju u drugom ili trećem kolenu, zemljoradnja kao zanimanje, infekcije mokraćnih puteva i neke vrste hrane.
Prema našim rezultatima 82% tumora gornjeg urotelijuma je lokalizovano u pijelonu i ureterima, istovremena pojava tumora u pijelonu i ureteru je zabeležena kod 18% bolesnika, a tumori se češće javljaju unilateralno nego bilateralno (82% vs. 18%). Tumori mokraćne bešike registrovani su kod 18% bolesnika.
Iako endemska nefropatija često prethodi pojavi tumora gornjeg urotelijuma, u žarištima endemske nefropatije  oko Lazarevca otkriveni su često i bolesnici  kod kojih su se tumori pojavili pre klinički manifestne endemske nefropatije. Kod bolesnika sa endemskom nefropatijom lečenih redovnim hemodijalizama u Lazarevcu tumori gornjeg urotelijuma zabeleženi su kod 29,8%.
Ključne reči: Tumori gornjeg urotelijuma, endemska nefropatija, Kolubara