Vitals & Voices

Urologic Health Explained: What’s Normal, What’s Not, and When to Get Help

• Lexington Regional Health Center • Season 2 • Episode 24

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In this episode of Vitals & Voices, we sit down with Dr. Matthew Rutman, visiting specialist urologist at Lexington Regional Health Center, to talk about a topic many people delay or avoid—when it’s time to see a urologist. Dr. Rutman breaks down what urology really involves, clears up common misconceptions, and explains why urologic care isn’t just for older adults or men.
From urinary symptoms and kidney stones to sexual health, incontinence, and preventive screenings, this conversation highlights how urologists often serve as long‑term partners in care for both men and women. Dr. Rutman also shares what patients can expect at their first visit and why many symptoms people assume are “just part of aging” are actually very treatable.

What You’ll Learn in This Episode:

  • What a urologist really does  and who they treat
  • Common signs and symptoms that shouldn’t be ignored
  • When to see a urologist before symptoms become severe
  • Why blood in the urine is never normal
  • How urologic care supports both men and women across all ages
  • What to expect during a first urology appointment
  • Why continuity and long‑term follow‑up matter in urologic health


Why This Episode Matters:
Many people live for years with urinary or pelvic symptoms because they feel embarrassed, unsure, or assume nothing can be done. Dr. Rutman emphasizes that urologic conditions are common, manageable, and often highly treatable especially when addressed early. With access to visiting specialists right here at Lexington Regional Health Center, patients don’t have to wait until symptoms become severe to get answers and relief. If something doesn’t feel right, this episode is a reassuring reminder that help is available and starting the conversation can make a meaningful difference in long‑term health.

Vitals & Voices is a podcast powered by Lexington Regional Health Center, offering meaningful health conversations that matter to you. Each episode features authentic stories and expert insights from the people behind the care — including healthcare professionals, wellness advocates, community leaders, and patients — all aimed at helping you live your healthiest, most informed life.

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SPEAKER_01

Welcome to Vitals and Voices, brought to you by Lexington Regional Health Center. Your community, your health, your care. This is your trusted source for health-related content that matters to you. Each episode, we will bring you real conversations with the voices behind the care, from medical experts and wellness champions to community leaders and patients, sharing insights, stories, and tips to help you live your healthiest life. Whether you're tuning in from Lexington or beyond, we're here to inform, inspire, and connect. Because at LRHC, your health is our priority and your voice matters.

SPEAKER_02

Hello, everyone, and welcome back to today's podcast. Today we are talking about something that I think a lot of people may be put off or they feel unsure about. But we want to know when is the best time to see urologists. So joining me is Dr. Matthew Rutman. He is a visiting specialist urologist here at Lexington Regional Health Center. Dr. Rutman, thanks for being here.

SPEAKER_00

Thank you for having me.

SPEAKER_02

So maybe just to start off, give some context to our audience, tell us a little bit about yourself, what got you to Lexington. We're so happy you're here.

SPEAKER_00

Sure. I uh so I was in academic practice at Columbia University in New York for roughly 20 years. Uh, I was a urologist, but also specialized in what sometimes is called female urology or urogynecology. So I took care of many men and women with urinary issues, um, including overactive bladder, incontinence, sometimes vaginal prolapse, uh, leakage with coughing, sneezing, lifting, which is sometimes called stress incontinence, urinary tract infections, as well as men that had enlarged prostates and other urinary difficulties. Uh, we had always desired to live in the mountains, and we were basically waiting for my younger son to graduate high school before we relocated. Um, and we moved just about a year ago to the mountains of Colorado in a place called Summit County. Um, and when we were looking for jobs and opportunities, my heart was really um a hundred percent behind doing something very different than what I did in New York. Um, in New York, I took care of a lot of tertiary care, so lots of third and fourth opinions. And not to say that I wasn't able to help patients, but I at times I felt like I was a little bit redundant. Um, and I really wanted to go somewhere where I could be needed, but also provide care to people who really needed care that weren't able to get access in other ways. Um, and so I started to um work with a company called InReach that works with rural critical access hospitals. Um, and I specifically work in in Nebraska and Wyoming. And so it's beautiful it's really been a wonderful experience so far. I get to take care of a wonderful population. I get to work with tremendous um staff and um colleagues and peers it at Lexington is one of my sites. Um, and at the same time, I get to really feel like I'm going back to sort of all the things that I learned initially in terms of being able to provide urologic care to the general population.

SPEAKER_02

Well, we're so happy you're here. And I know we're gonna dive into this more, but urology is just such a such a specialty that covers a lot of people. And so to have this service available here locally, I mean, it's just so important. So happy you're here. So on that note, when people hear urologists, what do you think they typically think or what what have maybe funny things have you gotten of people like, oh, I I didn't know you did that, or I thought you just did this.

SPEAKER_00

Yeah, I'll give you a quick little tidbit. When I was, you know, in my late 20s and in medical school, you spend time doing different rotations. And so I always thought I wanted to be like a a team doctor for the New York Giants football team.

SPEAKER_02

Because he wouldn't.

SPEAKER_00

I wanted to go into orthopedic surgery. I grew up playing sports and love sports. And uh when I made the decision that I actually liked urology, um, which we can get into in a couple seconds, I and I told all my friends about it, that everybody was disappointed because they thought, well, I I wanted someone to help me with my ankle or my shoulder or my knee. Um, and then subsequent to that, basically, the you know, the in the late 20s, it would be my friends calling me with infertility questions, or people calling me because they um wanted a vasectomy, or maybe somebody had a kidney stone, or maybe somebody fought somebody's father just got diagnosed with prostate cancer. So strangely, it I was actually busier giving advice and to family and friends than anybody thought initially. But you're absolutely right. I think most people don't know what a urologist is. Um, and an easy way to think about it is as urologists, we are surgeons by training, but we are the doctors that treat the entire urinary tract, which includes your kidneys, the ureters, the bladder, as well as the urethra. Um, in addition to that, we also treat the external genitalia. So people that have, let's say, a testicular growth or a cyst on the testicle. Um, and and same thing with female patients if they have an issue with a urethra or if the bladder or any of the organs are falling down. So I think that urology is a neat specialty because for many patients, we become somewhat of a primary care doctor. We're able to kind of monitor patients, let's say we're screening for prostate cancer and somebody who has a family history. Typically see those patients once a year. It's just for a routine checkup and an exam. Um, in the same way, women or men with overactive bladder, urinary symptoms, usually it's not something where you have to see us more than once a year, but for lots of patients, you get to develop a long-term, you know, doctor-patient relationship, which is really, really rewarding.

SPEAKER_02

I love that. So kind of hit on the areas. Can you talk a little bit about maybe some of the conditions that a urologist would treat?

SPEAKER_00

Yeah. I mean, I I think to think about there's different subspecialties sometimes in urology. So I mentioned kind of what my training or what I my fellowship was in, which is called female urology or female pelvic medicine. Um, but besides that, there's pediatric urology, and that typically, you know, can be a neonate all the way until adolescence, until they're 18 years of age. They can have some of the same conditions as adults. So they could have a kidney stone or have a urinary tract infection, or sometimes be born with something, something called a congenital anomaly. There is the issue of sexual health, both male and female. So as urologists, we tend to treat a lot of men that have issues with intimacy and erectile dysfunction. Um, and that's something that we could treat behaviorally, medically, as well as procedurally and surgically, surgically. Um, kidney stones is a big, big issue. Um, 5% of the population will have a kidney stone generally in their lifetime. Wow. Um, and of those who develop a kidney stone, about 50% will have another stone within five years. Uh, my wife had kidney stones when she was pregnant. I could tell you that, you know, in her words, that it's worse than than actually delivering a baby for many patients. Um, but we do manage um both to prevent kidney stones in patients who have had a history of them, as well as to actually intervene if somebody has an active kidney stone. The other things that we tend to deal with are things like if somebody has blood in the urine. Okay. So to evaluate that. Um, we took, we talked a little bit about the sexual health part, and then of course, all the different urinary difficulties. So people with incontinence, frequency, waking up at nighttime to pee, trouble urinating, um, general prostate-related issues or bladder-related issues. And then in addition to that, for a lot of people, we help to screen for things like prostate cancer. Okay. Um, prostate cancer is a very common um diagnosis. It's it's sort of a disease of aging men. You live long enough, you probably will develop prostate cancer. We're not trying to find these little ditzel prostate cancers that people are never going to be impacted by. We're trying to find ones that are more meaningful and might impact somebody's life.

SPEAKER_02

So for those listening that maybe are like, oh, you know, I think I think I'm doing pretty good. Are there any signs or symptoms that really stand out to you that maybe people overlook to that, hey, that kind of warrants coming in?

SPEAKER_00

Sure. Yeah, I would say on the male side, well, actually, yeah, for both both men and women, I would say it's never normal to see blood in the urine. That would always mandate a urologic visit and an evaluation. It doesn't mean you have bladder cancer. It could be a kidney stone, it could be a urinary tract infection, it could be a bladder stone, but definitely seeing a urologist is important. I would say for men that are interested, we tend to recommend coming in starting at about 50 for for prostate cancer screening. And then the other things to think about if you're somebody who seems like you're doing well urologically, would be do you have any urinary difficulties? If somebody is leaking urine, if somebody has urgency where they don't have time to get to the bathroom, um if somebody has trouble emptying their bladder, those are all things that can really be checked on pretty simply. And it's worth uh it's worth, you know, coming to see me or or another urologist just to have a brief checkup to figure things out.

SPEAKER_02

So along those same lines, are there anything that maybe before symptoms become severe, maybe somebody can deal with it for a little bit, but hey, in this instance, it's I mean, it's really important to get in sooner rather than later.

SPEAKER_00

Yeah. I mean, I would say if you're having pain anywhere along the urinary tract or testicular or scrotal pain or vaginal pain, um, I think if your organs feel like they're falling down or falling out, that would be a good reason to come in and have a have a checkup or an evaluation. You know, I I would say the other thing is if you're if you're sort of suffering with something that you think is age related. So I'll give you an example. If, you know, I see a lot of patients who come to see me and for like five or 10 years they've had leakage of urine and they've just been dealing with it because they just thought it was a normal part of aging. I think that that's something that's pretty straightforward. There's behavioral treatments that we could do, there's exercise programs, there's medications, procedures, and surgeries. And typically we don't get to the point where we need procedures or surgeries. So having a checkup, I think is important. You know, I would say the biggest things were if you had severe pain, blood in the urine, um, you know, a urinary tract infection with a fever or anything like that, then you'd want to come in and be seen immediately.

SPEAKER_02

Get in sooner rather than later. Yes.

SPEAKER_00

Absolutely.

SPEAKER_02

Let us help you. Um, so you talked about this a little bit, but why do you think the continuity of just, you know, you being able to see patients for a lifetime, why is that so important important in urologic care?

SPEAKER_00

Yeah, I I think, you know, for for a couple of reasons. Number one, it's it's rewarding to get to know somebody, to get to know their family. Maybe you took care of their child or their sibling or their parent. Um, so on a personal level, that's always a nice touch for um for me to be able to interact with patients in the long haul. I think for urology, for many of the conditions that we're dealing with, whether it's screening for prostate cancer or it's a patient who has prostate cancer who maybe we're observing or something we call active surveillance. So not treating, but making sure it doesn't change or get worse, um, as well as many bladder conditions or an inl or prostate condition. These are lifelong chronic conditions, but oftentimes ones that can be managed very simply with just periodic yearly follow-up. Okay. So I think it's always easier to assess somebody when you've seen them multiple times versus just one time. So I'll give you an example. There's a blood test that we use called PSA. It stands for prostate specific antigen.

SPEAKER_02

Okay.

SPEAKER_00

A lot of times patients come in to see us, they've had one of those blood tests, it comes back a little bit abnormal. And then we might check it again in two or three months. And it's still about the same number. And maybe we get into the program of we'll check you every six months. If that number stays stable, we don't worry so much about one value. Right. So, not to say that we have to see somebody every three months, but the more interactions we have, the more visits we have, the more data we have, the more we're able to sort of interpret that data to decide on next steps along the process.

SPEAKER_02

Sure, be able to catch it before it gets too severe, too. Correct. Yeah. Okay. So urology care for women. Talk to us a little bit about that. I know you talked a little bit about leakage, but are there any, you know, women's body and men, uh, but women for, you know, childbirth and all those things just goes through so much. Do you see a lot of new moms or women in that kind of childbirthing years?

SPEAKER_00

Yes. So, you know, what I would say is an easy way to think about urine leakage, we oftentimes call that incontinence. Incontinence is when you lose urine when you don't want to. Um, so the there's two types that we deal with most commonly. One is called stress incontinence, and that's when you have leakage when you cough or you sneeze or you lift or you do exertional activities. It'd be better to call it exertional incontinence, because I think sometimes stress makes patients think it's because I'm nervous or anxious, but it's not that. Sure. Um, so for stress incontinence, the two peaks that we see that in one are people who've just had children or gone through some vaginal deliveries, oftentimes. Um, and then the second peak is around menopause, and that's due to hormonal changes. So those are the that's one sort of bucket in terms of incontinence. The other is what we call urgency incontinence. And we define urgency incontinence as a sudden desire to urinate, which you find difficult to postpone. And if you can't get to the toilet in time and you lose urine, that's called urgency incontinence. Okay. That is the hallmark symptom or complex of overactive bladder. Um, and I think that we start to see this in adults really over 18 years of age. The prevalence is about one in seven adults in the United States and actually worldwise worldwide, and that's in males and females. Um, more common in women that are younger, and as you get older, the men tend to catch up in terms of the prevalence of the condition. Okay. Um, so I think that both of those two things are key things to highlight. Neither of them is normal, and they're both absolutely treatable and treatable without a lot of headache. Um, and then the other thing to think about are people who get infections, and this could happen with something we call honeymoon cystitis, so infections related to sexual relations, um, as well as infections that occur in people um who have nothing wrong with them, but just periodically get a urinary tract infection, as well as post-menopausal women as well.

SPEAKER_02

So a good reminder, you do not have to live with these symptoms. We want you, we want you to feel good, feel good in your own skin.

SPEAKER_00

Absolutely.

SPEAKER_02

So I this is kind of a loaded question and everyone's gonna be different, but a patient coming into the urologist for the first time, what what do you kind of go through on an initial visit? What does that look like for someone who maybe is nervous?

SPEAKER_00

Sure. Yeah, I think that that's a that's a great question and an important one because I think sometimes patients are afraid to go to the urologist because they read something on the internet or on WebMD and they're like, whoa, whoa, whoa, I don't want to do that. Right. Um, you know, I would say 99% of the time, none of that stuff is being done on an initial visit. Typically it's just a a conversation, what we call a history of the of the present illness. Um, sometimes a physical exam, but usually it's a a focused physical exam. So it doesn't require invasive um part to the physical exam. A lot of times we'll do a urine ex a urine test. And then we do do something a lot of times, particularly with someone with urinary complaints called a post-void residual, where we just take a little portable ultrasound probe, it goes right underneath your belly button, and we just see how well your bladder is emptying. I would say for nine out of 10 patients, that's the initial visit. Um, it's pretty straightforward. There's nothing to be afraid of. If it's a male who's interested in being screened for prostate cancer, then we would also do a blood test. Um, that's a PSA test done by a you know certified tech that's really good at doing blood draws. Um, so it's it's a pretty straightforward process. And I think patients should feel comfortable knowing that the this this does not require telescopes or biopsies or um any sort of you know complex testing in the majority of cases.

SPEAKER_02

So there's, I mean, I'm sure people will be, but there's no need to be nervous or embarrassed. This is, I mean, part of the human body, obviously, we have an entire specialty dedicated to this. It's it affects a lot of people.

SPEAKER_00

Yes. I I always joke around when when people hear that I'm a urologist, like in the outside world, um, you become almost like the local bartender. Like people, people feel pretty comfortable talking to us about anything. Um, and and I think that any patients out there, some of these issues are clearly sensitive, but you should know that there are specialists that are focused on helping improve your quality of life and helping to make sure that you have no urologic problems in the long run and were immediately available and accessible. And the worst case scenario is you you you spent a half hour, you had a conversation and and it stopped at that point, but you may as well get an education um from somebody who does this every day.

SPEAKER_02

Something can make you better in the long run. It I mean, it'd be worth trying, especially with some of these.

SPEAKER_00

Sure.

SPEAKER_02

Can't imagine going through life leaking all the time. That would not be fun for anyone. So, Dr. Rutman, what is one message you want our listeners to remember about urology, about the specialty? Something to take home with them.

SPEAKER_00

Yeah, I I I think I think that I guess I would conclude by saying a couple things. First of all, I think that for everybody in the community, you're super fortunate. I think Lexington Regional is a wonderful healthcare center. Um, like I said, I I trained in uh or I spent 20 plus years in New York at Columbia, which is, you know, by the metrics, a top five hospital in the country. Um and I will tell you that you you have wonderful resources here in Lexington. You have an amazing community. You have a tremendous amount of ability to navigate through that in a really lovely community setting. And on top of that, you have surgeon specialists that come to visit. Um, and and that's not to say that those surgeons wouldn't like to live somewhere like Lexington, but honestly, the the community is small enough that it probably doesn't need full-time specialists 20 days a month. So rotating and having specialists that come through, I just think the the community in the area at large is is very fortunate because you kind of get the best of both worlds. Um, you know, what I would say is from a urologic perspective, with that I am at Lexington two days a month. Um, and although I'm only there two days a month, I I try to make myself accessible. I I check the electronic medical record, I communicate with my staff. Um, and so patients can feel like, oh, well, if I didn't get to see him for this day, I'm now gonna have to wait 13 days. You generally shouldn't have to. We do our best to even add on visits the same day. Um, and in the rare cases where there's an emergency that happens between my visits, I could tell you that we will definitely help navigate you to the best place um and to be in the best hands as opposed to um having to restart that process when we're not here.

SPEAKER_02

I love that. Um talk just a little bit about I know um surgery is not needed for everyone, but maybe a general overview on the types of surgeries available should a should a patient need that.

SPEAKER_00

Yeah, I mean, the most common surgeries that that urologists do are usually related to prostate health. So there's something called BPH. Um, and we do surgeries where we help to open up the prostate channel to make it easier for men to urinate. Um, we do similar types of procedures in women that have leakage issues. So there's procedures that could be done to help with the leakage called stress incontinence, as well as um different procedures for overactive bladder beyond medications, as I mentioned. Um, those types of procedures include putting Botox into the bladder, kind of to relax the bladder to help with leakage. As well, it can um there are pacemakers for the bladder that can help to um make the bladder behave, whether it's underactive or overactive. The other types of procedures that we often do include vasectomy, um, sometimes circumcisions for patients that that choose to do that, uh, as well as kidney stone surgery, prostate biopsies, um, sometimes small scroll procedures. And then, of course, you know, in the rare cases, if somebody did have a urologic cancer, that that might ultimately need treatment as well. And that's something that urologists are trained to do.

SPEAKER_02

It's just good to know. I think some of those things kind of at least slip my mind too, but good to know that those are able to be offered.

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Dr.

SPEAKER_02

Rutman, what didn't we hit on? Is there any anything else?

SPEAKER_00

I think we've covered it well. It's been a it's been a pleasure and an honor to be with you here today. And I thank you for the opportunity. And uh, you know, I I I guess my my last message out there is if anybody's thinking, hey, maybe I should see a urologist or maybe I do have this issue, even if it's not super pressing, I think it's worthwhile to to come and visit us um and to to get an education and we can help to decide that together.

SPEAKER_02

And even just to know, okay, even if it's not right now, if it gets worse, you know, hey, this is signs to look for. So give people some some knowledge. Yeah.

SPEAKER_00

I I I guess I would answer that as well by saying that for many patients who come to see us, we we actually recommend something called observation, which means that we don't think you need a medication. We don't think anything need more needs to be done. And and oftentimes we'll say just check in with us in a year. And if things change, we're there and ready and able to help provide some care for you if needed.

SPEAKER_02

I love that. Well, Dr. Rutman, thank you so much for sharing about this. I know here at Lexington Regional, we're very happy to be able to offer this. Service and have you to help support our community. To our listeners, I'm sure that you heard all of the good information, but you do not need to wait until something is severe or until later in life to see a urologist. We are happy to help you stay healthy over the long term. And to learn more about our urology services, please visit our website or you can call our outpatient services clinic to schedule. If you would, please like, share, and subscribe to our podcast. And until next time, stay well.