Former President Bill Clinton made the news last week when he was hospitalized for potentially deadly sepsis.
Not surprisingly, the media mostly stressed that Clinton, who landed at the University of California Medical Center at Irvine, was not infected with COVID-19 .
Clinton’s doctors said he had sepsis, a blood infection diagnosed in at least 1.7 million adult Americans per year, of whom 270,000 will die, according to the Centers for Disease Control and Prevention. The doctors said the sepsis came from a urinary tract infection.
But what caused that urinary tract infection?
This is still unanswered. The answer potentially could help thousands of men who contract sepsis from a urinary tract infection,
Clinton’s office and the Orange County hospital did not respond to questions about why he got sepsis. There could be a number of causes.
One authority on urosepsis, who asked not to be named, suggested that Clinton likely had undergone a transrectal biopsy for prostate cancer that caused the infection.
Transrectal biopsies, performed on 2 million American men per year, involve puncturing the rectum to remove small samples of prostate tissue. The goal is to confirm or rule out prostate cancer.
Campaigns have been conducted in several European countries and Australia to ban transrectal biopsies because of sepsis infections and some deaths caused by the infection.
The European Association of Urology recently adopted a guideline recommending a safer biopsy. This is the transperineal biopsy, which is performed through disinfected skin in the perineum, the area between the anus and scrotum.
TRexit (transrectal exit), a leading group of prostate experts calling for a ban of transrectal biopsies by the end of 2022, has been working to ban transrectal biopsies worldwide by 2022. Recent research has confirmed that sepsis drops down to near zero when the transperineal approach is taken.
The American Urological Association has been lagging behind on this issue largely because of financial issues. U.S. urologists possibly want to be paid more for the slightly more time-consuming TP biopsies. The AUA debated the issue at its annual meeting last month and is exploring changes to its guidelines, possibly by 2023.
Jeremy Grummet, an associate professor at Monash University in Melbourne, is a leading researcher in Australia where most biopsies are done via the skin with near-zero rates of infection.
Grummet, who leads TRexit, observed: “If President Clinton’s urosepsis was caused by a doctor performing a transrectal biopsy, there could be no louder wake-up call to American men to demand their doctors switch to the safer transperineal prostate biopsy.”
Two other urosepsis experts said causes of sepsis include “bad” kidney stones and indwelling catheters/stents.
Clinton should have no reason to hide the cause of his sepsis. He is no longer a candidate who might want to hide that he has cancer, especially one many men find difficult to discuss because treatment can cause impotence and incontinence.
He is not obligated to speak publicly about his health But he is a man with a proven social conscience.
He should provide answers to these questions:
- Has he ever had urinary stones?
- Does he have a bacterial form of prostatitis?
- Since he has experienced other inflammatory diseases, does he have an elevated PSA, the blood test used to hunt for prostate cancer?
- Has he recently had a transrectal biopsy?
Clinton’s hospitalization flew under the radar. The story was eclipsed this week by the COVID-19-related death of former Secretary of State Colin Powell, who spoke about his surgery for prostate cancer, a major issue in Black men.
Clinton should recognize that if he and his doctors detail his sepsis, it potentially could help men make choices about their health and steer them towards the safer transperineal biopsy.
Howard Wolinsky is the former medical reporter for the Chicago Sun-Times. He is a prostate cancer patient and advocate.