A discovery, innovation, or scientific study within the field of surgery

Dr. Chui Ka Lun has been the principal pioneer in introducing and standardizing the transperineal (TP) ultrasound-guided prostate biopsy in Hong Kong, effectively replacing the traditional transrectal (TR) approach. Historically, the transrectal approach was the gold standard but carried a significant risk of severe complications, notably post-biopsy urosepsis, due to the needle passing through the rectum's faecal flora. Dr. Chui initiated the TP approach under local anaesthesia at his institution in 2018. He subsequently co-authored the first comparative study in Hong Kong demonstrating the clinical superiority of the TP approach. His work established a comprehensive, scalable biopsy protocol (ranging from 10 to 24 cores based on prostate size) that could be performed as a day-case procedure under local anaesthesia, completely avoiding rectal mucosa penetration [1] [2].

Has changed clinical practice

Dr. Chui’s foundational work and subsequent publications catalysed a complete paradigm shift in urological practice across Hong Kong. Following his 2018 initiative and the publication of his comparative study in 2019, there was a territory-wide "Trexit" (transrectal exit) movement. By 2019, the transperineal approach had gradually replaced the transrectal route as the standard of care for prostate biopsies in Hong Kong [3]. This shift fundamentally altered how urologists in the region diagnose prostate cancer. Furthermore, the mastery of the transperineal approach laid the essential anatomical and technical groundwork for a wave of downstream surgical innovations. Urologists, now proficient in transperineal access, have successfully introduced multimodality focal therapies, including High-Intensity Focused Ultrasound (HIFU), cryotherapy, Targeted Microwave Ablation (TMA), and NanoKnife (Irreversible Electroporation) [4] [5]. Dr. Chui has also extended this technique to assist in radiation oncology, pioneering the transperineal injection of rectal spacers (SpaceOAR) and fiducial gold markers to protect the rectum during Stereotactic Body Radiation Therapy (SBRT) and proton therapy for pelvic malignancies [6].

Has had a profound impact on patient care

The transition to transperineal prostate biopsy has yielded immediate and profound benefits for patient safety and healthcare economics. The most critical impact is the near-elimination of post-biopsy urosepsis. Previous territory-wide data indicated that TR biopsies resulted in a 5.7% emergency attendance rate and a 3.8% hospitalisation rate, with up to 0.9% of patients requiring ICU admission for severe urosepsis [7]. Dr. Chui's comparative study demonstrated a reduction of infection and fever rates from 4% (requiring 1-week IV antibiotics) down to 0% [1]. This has spared countless patients from life-threatening infections, eliminated the associated psychological trauma, and significantly reduced the financial burden on the public healthcare system by decreasing emergency room visits, hospital bed occupancy, and intensive care admissions. Additionally, the shift has mitigated the growing public health crisis of antimicrobial resistance, as the TP approach dramatically reduces the reliance on broad-spectrum prophylactic antibiotics, such as fluoroquinolones, which were previously mandated for TR biopsies [3].Beyond diagnostics, the downstream innovations facilitated by Dr. Chui’s transperineal techniques have further enhanced patient quality of life. The introduction of transperineal focal therapies allows for the precise eradication of cancer cells while preserving urinary continence and sexual function [4]. The use of transperineal rectal spacers in SBRT and proton therapy has minimized gastrointestinal toxicities, ensuring exceptional tolerability for patients undergoing radiation for localized prostate cancer [6].

Publications

1.Lo KL, Chui KL, Leung CH, Ma SF, Lim K, Ng T, Wong J, Li JKM, Mak SK, Ng CF. "Outcomes of transperineal and transrectal ultrasound-guided prostate biopsy." Hong Kong Medical Journal, 2019 Jun;25(3):209-15. (First published comparative study in HK demonstrating the safety and efficacy of the TP approach).

2.Lo KL, Leung D, Lai Z, Li C, Ma SF, Wong J, Yuen KK, Li J, Chiu P, Mak SK, Wong J, Ng CF. "Picture-in-picture video demonstration of systematic transperineal prostate biopsy." Hong Kong Medical Journal, 2021 Aug;27(4):304-5. (Demonstrates the standardized TP biopsy protocol initiated by Dr. Chui).

3.Chiu PKF, Ng CF. "Primum non nocere (first, to do no harm) in prostate biopsy." Hong Kong Medical Journal, 2019 Oct;25(5):344-5. (Editorial highlighting the paradigm shift to TP biopsy in HK, citing Dr. Chui's work).

4.Yee CH, Chiu PKF, Liu AQ, Wong HF, Chan WHC, et al. "Multimodality focal therapy for prostate cancer: outcome of the à la carte approach in clinical practice." Prostate International, 2025.

5.Chiu PKF, Chan CH, Yee CH, Lau SY, et al. "Transperineal targeted microwave ablation (TMA) of localized prostate cancer guided by MRI-ultrasound fusion and organ-based tracking: a pilot study." Prostate Cancer and Prostatic Diseases, 2023.

6.Poon DMC, et al. "One-year clinical outcomes of MR-guided stereotactic body radiation therapy with rectal spacer for patients with localized prostate cancer." World Journal of Urology, 2024.

7.Cheng KC, Lam WC, Chan HC, et al. "Emergency attendances and hospitalisations for complications after transrectal ultrasound-guided prostate biopsies: a five-year retrospective multicentre study." Hong Kong Medical Journal, 2019 Oct;25(5):349-55.

References:

[1]: https://www.hkmj.org/abstracts/v25n3/209.htm

[2]: https://www.hkmj.org/abstracts/v27n4/304.htm

[3]: https://www.hkmj.org/abstracts/v25n5/344.htm

[4]: https://www.sciencedirect.com/science/article/pii/S2287888225000406

[5]: https://www.nature.com/articles/s41391-022-00577-8

[6]: https://link.springer.com/article/10.1007/s00345-024-04784-x

[7]: https://www.hkmj.org/abstracts/v25n5/349.htm