Present-day andrology falls into two branches -- surgical and conservative. Surgical andrology has been developing more intensively both in Russia and abroad. We explain this by surgical mentality of many andrologists, surgeons in the past, and insufficient effectiveness of nonsurgical techniques. In fact, conservative andrology is a new discipline and SANOS represents one of the pioneer centers in which conservative treatment is a priority. We were the first among andrologists who proposed techniques of conservative treatment of the majority of andrological patients.

Most common male diseases are chronic prostatitis, benign prostatic hyperplasia (known in the past as adenoma), prostatic cancer. Chronic prostatitis occurs at any age including adolescents and young men. At the age of 20-50 years 50-60% of men have this disease. Adenoma of the prostate arises most commonly in men over 50 years of age. Up to 40% of men at this age have adenoma. With advancing age it affects more and more men. Prostatic cancer develops most frequently in old men. Our center does not conduct treatment of prostatic cancer. Each of the above diseases can run alone or in combination making the diagnosis rather problematic.

Although clinical manifestations of male diseases vary, most frequent are five groups of complaints:

• urination disorders (pollakiuria, dysuria, urodynia, nocturnal enuresis, etc);
• sexual dysfunction (weak erection, premature ejaculation, painful orgasm, abnormal libido, etc.);
• pain or dyscomfort in the area of sexual organs (in low abdomen, perineum, testes, penis, sacrum, groin, urethral itch, etc.);
• urethral discharge (purulent, sanguinolent, mucosal, etc.);
• male infertility.

Each of these complaints is encounted alone or in combination or may be absent even in advanced disease. As the absence of the symptoms does not warrant health in men they need regular andrological check-ups not less than women need gynecological check-ups.

Understanding of male sexual organs anatomy and physiology helps to understand male diseases better. Figure 1 illustrates anatomical structure of male sexual organs.

Fig. 1. Anatomic structure of male sexual organs.

1. Urinary bladder. 2. Ejaculatory duct. 3. Seminal vesicle. 4. Prostatic gland. 5. Seminal tubercle. 6. Excretory ducts of prostatic lobes. 7. Cowper's glands. 8. Urogenital diaphragm. 9. Urethra. 10. Spongy bodies of the penis. 11. Testes with the epididymis. 12. Scrotum.

Fig. 2. Anatomic structure of the prostatic gland.

1. Prostatic gland. 2. Urinary bladder. 3. Seminal vesicles. 4. Posterior urethra. 5. Seminal tubercle. 6. Excretory lobular ducts. 7. Normal lobes.

The chief functional unit of the prostate are its lobes surrounded by a thick layer of smooth muscles. In ejaculation the muscles actively contract and make the lobes to release secretion containing nutrients for spermatozoa. In addition, prostate produces various physiologically active compounds participating directly in regulation of sexual function and mechanism of erection. In this respect its role is as important as that of the testes. Thus, the prostatic gland plays a key role both in sexual male function and his fertility.

Chronic prostatitis is an infectious disease of the prostatic gland caused by various microbes including sexually transmitted. Among the causative agents most common are chlamydia, mycoplasma, ureaplasma, viruses, gonococci, trichomonades, staphylococci, streptococci, anaerobic infection, etc.

Figure 3. The picture of chronic prostatitis (morphological and ultrasonic evidence).1.Prostatic gland. 2. Urinary bladder. 3. Seminal vesicles. 4. Posterior urethra. 5. Seminal tubercle. 6. Excretory lobular ducts. 7. Normal lobes. 8. Moderately ectatic lobes. 9. Significantly ectatic lobes. 10. Significantly ectatic lobes with "plugs". 11. Microabscess with liquid pus. 12. Microabscess filled with dense inflammatory detritis. 13. Electrode-catheter.

As shown in figure 3, in chronic prostatitis excretory lobular ducts are "packed" with "plugs" while the lobes contain pus produced as a result of microorganisms activity. In other words, the prostate contains closed purulent cavities (microabscesses) in which latent pathogenic microflora vegetates. All this was discovered by ultrasound investigations conducted in the center SANOS with a special rectal sensor. The size of these microabscesses are very small, (1-22 mm) not larger than a millet seed. It is this small size that explains why previous efforts to discover microabscesses with standard sensors failed though the presence of microabscesses was known as early as 1930s when morphological postmortem examinations were made. We see our contribution in that we now can detect the microabscesses clinically, i.e. with ultrasound.

We found ourselves at a loss because, according to conventional medical laws, any closed foci of purulent inflammation should be treated surgically. i.e. any abscess should be opened and pus should go outside. As the conventional treatment cannot do this, its results are poor.

Later, we came to the conclusion that conventional treatment is not only low-effective but can bring a direct damage to the patient. Lets take finger massage of the prostate as an example. This massage implies a rough mechanical impact on the prostate which inevitably results in crushing the microabscesses and further penetration of the infection inside the organ and outside it (Figure 4).

Figure 4. Transrectal ultrasound investigation of the prostate. Patient L., born in 1973. The sequelae of finger massage. The red arrow points to the zone of low density of the tissue outside the capsule of the anterior urethra (inflammatory edema). The yellow dotted arrow shows the direction of the finger movement in the massage. For a few weeks such treatment improves the condition of the patient but deterioration is inevitable. The cause is simple: the crushed abscesses relieved internal pressure in the tissues, pain alleviated but 1-2 weeks later the inflammation intensifies in places where the infection spreads after the massage and therefore, the progression of the disease is highly probable.

Recent history of chronic prostatitis treatment in the West European countries began with use of massage as basic therapy of the disease (up to 1968), then rejection of the massage as uneffective method took place followed by introduction of antibacterial treatment which has remained leading until now. To our regret, nowadays we observe attempts to rehabilitate finger massage of the prostate in chronic prostatitis. For example, a group of Philippine physicians is actively practicing and promoting finger massage in chronic prostatitis with the connivance of some urologists from the West countries and America who do nothing to talk patients out of going to Manila and taking treatment long ago rejected in their own countries as doubtful.

Antibiotics against chronic prostatitis have also fallen short of the expectations. In some cases they bring more harm than benefit because it is impossible for medicines to penetrate into the closed cavities. Moreover, as identification of the infection in the closed prostatic cavities with common methods of letting pus out is extremely difficult, antibiotics frequently are selected ramdomly. And, finally, long-term administration of antibiotics threatens with serious complications: total dysbacteriosis, secondary immunodeficiency. Other methods of treatment have also proved low-effective if the prostate contains microabscesses encounted in 70% of cases.

The question is: what to do to cope with this intricate problem. We answer: SANOS center has the solution. We have developed and for 10 years tried a noval highly effective method which provides good short- and long-term outcomes in chronic prostatitis. To introduce the new treatment, we had to conduct long investigations, design advanced diagnostic and therapeutic techniques, equipment, and, at last, to organize a specialized andrological center which has grown to our SANOS center.