There are certain health concerns many people would rather not talk about. Urinary leakage. An enlarged prostate. Erectile dysfunction. A rising PSA. Embarrassment or fear can prevent some patients from mentioning symptoms to their primary care physicians.

Dr. Tristan Keys, a urologist who has practiced in Asheville for nine years at Mission Health/HCA Healthcare, hopes men and women will reconsider their hesitation. Keys believes one of the most important parts of his job is listening.

“Every person is human and deserves to be heard,” he says. “Today there are a multitude of treatment options.”

Keys says he was drawn to medicine early. He enjoyed science and biology and was fascinated by the human body. Becoming a physician simply seemed like a recurring theme and a natural direction for his life.

Urology offered something he found especially rewarding: the opportunity to combine surgery, technology, problem-solving and long-term relationships with patients. His day entails both complex and simple procedures.

“One of the things I really enjoy about urology is the breadth of patients that I get to care for,” he says. “Unlike some surgical specialties, urology allows me to develop relationships with patients over many years.”

Each day is different. One day he may see a patient in their late teens; the next, someone in their 80s or 90s. He treats conditions involving the kidneys, bladder, ureters, urethra and prostate, ranging from kidney stones and urinary symptoms to prostate and bladder cancer.

He may meet a man because of an elevated PSA, guide him through an evaluation and, if prostate cancer is diagnosed, help him navigate treatment and ongoing monitoring.

“That ability to see patients through the process, help them be better and not suffer, and then see the outcomes and follow them over time is incredibly rewarding,” he says.

Urinary symptoms are among the concerns people may dismiss or simply accept as part of aging. Frequent urination, difficulty emptying the bladder, urgency or leakage can have a significant impact on quality of life.

The same is true for erectile dysfunction.

“Some men are very forthcoming with it and some are not,” Keys says. But erectile dysfunction is a health concern worth discussing with a physician rather than something men simply have to live with. Keys encourages men to start with their primary care physician, who can help them determine whether a urologic evaluation is appropriate.

“We have great primary care doctors in Asheville,” he says. “They are the quarterback and they can get you in to see us and address the health care concern.”

Keys likes to give patients agency. The goal, he says, is helping people age with dignity, comfort and the best quality of life possible.

For men, prostate health becomes increasingly important with age. Keys says he tends to see many patients in their 50s, 60s and 70s, when conditions such as benign prostatic hyperplasia (BPH), urinary symptoms and prostate cancer become more common.

One of the tools used in evaluating prostate health is the PSA, or prostate-specific antigen, blood test. Keys recommends that men talk with their primary care physician about prostate cancer screening. Urologists often become involved when a screening test or symptoms raise a concern.

Keys also treats men with enlarged prostates, prostatitis and other conditions affecting urinary and sexual health.

If you’ve ever experienced a kidney stone, you probably don’t need to be reminded how painful they can be. Keys says the Southeast has a particularly high incidence of kidney stones, earning the region the nickname the “Stone Belt.” The climate is one contributing factor, he says. Hot temperatures lead to more sweating, and dehydration can increase the risk of stone formation.

Metabolic conditions such as diabetes and high blood pressure can also contribute to the higher prevalence of kidney stones in the region. (It’s not just the sweet tea!)

Keys treats patients across the age spectrum for stones. Some can be managed medically, particularly when the goal is preventing future stones. Others are too large to pass naturally and require a surgical procedure.

Urology has long been at the forefront of technological advances in medicine, from minimally invasive surgery to robotic-assisted procedures and increasingly sophisticated lasers.

Keys jokes that he gets to play with a lot of technology “toys” in the operating room and office.

Lasers are used to treat certain kidney stones, while robotic-assisted laparoscopic surgery can be used for a variety of complex procedures.

Technology is also expanding treatment options for patients with urinary incontinence and an overactive bladder. Nerve stimulation techniques, for example, can help some patients whose bladder symptoms have not responded adequately to other treatments.

Incontinence, in particular, is something Keys says can be addressed with numerous treatment options.

Every patient brings a different experience, history and set of priorities into the exam room. Keys says physicians have to meet patients where they are and understand what matters to them.

“There is an educational component that is important,” Keys says. “Simply understanding what’s happening can have a therapeutic effect because it takes away some of the fear of the unknown. Helping patients live healthier lives and maintain their quality of life for as long as possible is incredibly rewarding.”

Keys’ commitment to medicine is shared by his wife, Dr. Haley A. Neal, who is also a physician and works in hospice and palliative care and addiction medicine.

Together, they are raising three children, two daughters, a 12-year-old and 10-year-old, and a 6-year-old son. Keys says when he’s not at the office, he’s trying to keep up with the three kids.

Both he and his wife find tremendous fulfillment in their work. “We both found what we love, and when you love what you do, you don’t work a day in your life.”