PHILADELPHIA—Pediatric urologist Howard M. Snyder III has pioneered treatment for complex urinary tract and urogenital anomalies. He developed and taught one-step hypospadias repair to generations of students, and made progress in diagnosing and managing patients with undescended testicles.

It’s increasingly clear that erectile dysfunction (ED) is strongly linked to a range of underlying ailments including systemic vascular disease, diabetes, and obesity. These disorders, in turn, are associated with diet, exercise, and other lifestyle and emotional factors.

A mural featuring a sun-dappled lake, crimson and azure birds, lush flowers, and palm trees adorns one waiting room wall. In another, a comfy couch beckons; a cheery blaze crackles in the fireplace, and the aroma of hot coffee wafts from an adjacent kitchenette.

Nephrologist Jean Holley, MD, will never forget Deena and Mary (not their real names), two patients with end-stage renal disease (ESRD) she cared for 20 years ago who asked her to let them die. Deena, a widow in her 70s, had been on hemodialysis for eight years. Mary, who was in her late 40s and severely diabetic, needed to begin dialysis immediately to survive. Deena wanted to stop dialysis; Mary did not want to start. In both cases, refusal would almost certainly lead to death in less than a month.

"My wife says the only time she realizes I'm retired is on payday," said James E. Cimino, MD, one recent morning, glancing down at his Mickey Mouse watch to make sure he was on schedule. Although he officially retired from his position as director of the Palliative Care Institute at Calvary Hospital in the Bronx in 2003, Dr. Cimino, 78, is lively, engaged, and continues to meet regularly with medical students and work on special projects.