The procedure is carried out in a hospital, and the patient usually remains overnight. It is performed under local (spinal or epidural) or general anesthesia, with techniques similar to those used in implanting seeds in radiation seed therapy. Long needles are inserted into the prostate through the perineum. A freezing substance (liquid nitrogen was utilized in the past, but argon gas is now used) is inserted through the needles and the prostate is frozen into what is memorably referred to as an ice ball. An ultrasound probe is inserted into the rectum so that the urologist can carefully place the needles and ensure that tissue outside the prostate is not frozen. Because the urethra runs directly through the prostate, a catheter carrying warm, circulating water is inserted through it so that the urethra will not also be frozen. Following the procedure, a urinary catheter is left in place for approximately two weeks, during which time most men do not go back to work.
The complications of cryotherapy are fewer now than in the past. The most dangerous possibility is freezing the wall of the rectum, which is immediately behind the prostate, thereby creating a fistula (hole) between the bladder and the rectum. This complication is very ti-r"^^
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