Expertise in the treatment of urinary incontinence, pelvic organ prolapse, uterine and vaginal prolapse, overactive bladder, cystocele, rectocele, enterocele, stress incontinence, urinary tract infections, female pelvic floor disorders, vaginal laxity, labial enlargement, mesh complications, and complications from previous surgery
When the roof the vagina starts to bulge, this is called a cystocele. Our team uses a specialized technique that pulls up to its natural attachments.
A rectocele is a bulge that occurs on the floor of the vagina. Dr. Garely can fix this with tiny incisions, without distorting the normal anatomy.
When the bowels push the vagina down. This can be repaired vaginally, abdominally, or laparoscopically depending on many variables.
When the vagina starts to drop or turn "inside out", we are able to use laparoscopic instruments to complete a total pelvic reconstruction.
Women who have a bulge caused by the dropping of the uterus can be treated with both surgical and non-surgical methods.
Women who leak urine when the cough, laugh, sneeze, or exercise can be treated with a minimally invasive procedure called a sling. We also offer biofeedback and pelvic floor therapy.
Women who urinate frequently, have uncontrollable urges to void, and leak without control, will usually respond to pharmacologic therapy.
Some women are born with the congenital absence of a functional vagina. Dr. Garely uses the minimally invasive Vecchietti Procedure, and in some cases, graft augmentation neovagina.
Doctor's Garely and Liberman were among the first Board Certified physicians in Female Pelvic Medicine and Reconstructive Surgery. Dr. Rahimi is Board Certified in Obstetrics and Gynecology and is Board Eligible in Female Pelvic Medicine and Reconstructive Surgery.
The field of Urogynecology is relatively new. This specialty, now called Female Pelvic Medicine and Reconstructive Surgery, requires a full residency in either Ob/Gyn or Urology followed by either two or three years of formal fellowship training. Physicians who complete this rigorous training path are uniquely qualified to care for women with pelvic floor disorders. Because of the scarcity of training programs throughout the US, most medical centers do not have a specialist in this area. Dr. Garely is a Clinical Professor at Mount Sinai, which is one of only 2 medical centers in New York City with an accredited fellowship program. As a fellowship graduate in Urogynecology, Dr. Garely has been practicing the longest in the New York City area.
The first board exam used to certify doctors who practice Urogynecology was given in June, 2013. Both Dr’s. Garely and Liberman are now Board-Certified in this specialty, in addition to being certified in general obstetrics and gynecology.
Female pelvic floor disorders can be the source of great anxiety. Common symptoms include loss of bladder control (leaking) when coughing, laughing, sneezing, or exercising (stress incontinence). Sometimes, the problem involves having to go to the bathroom frequently, or not being able to sleep through the night because of constant urges (overactive bladder). Often, women can have the sensation of pelvic pressure, or feeling a "bulge" in the vagina (uterine or vaginal prolapse). Sometimes women can have problems after previous surgery which can lead to pelvic pain, or openings that can form between the bladder, rectum, and vagina (fistula's). Rarely, some women are born with congenital problems which can affect their sexual function.
Dr's. Garely and Liberman are now among the first Board Certified physicians in Female Pelvic Medicine and Reconstructive Surgery
Chair of Obstetrics and Gynecology,
Director of Urogynecology and Pelvic Reconstructive Surgery
Mount Sinai South Nassau
Clinical Professor of Obstetrics, Gynecology and Reproductive Science, The Mount Sinai School Of Medicine.
A graduate of Hampshire College in Amherst, MA, he obtained his MD from Saint George's University School of Medicine. Dr. Garely completed his residency in Obstetrics and Gynecology at Saint Vincent's Hospital and Medical Center of New York, and did two fellowships in Urogynecology and Pelvic Reconstructive Surgery. The first was at the University of Connecticut/Mt. Sinai Hospital, and then at the Louisiana State University Medical Center of New Orleans.
Dr. Garely has served on the Board of Directors for the American Urogynecologic Society. He is currently the Chair of the Gynecology and Obstetrics Advisory Board for the American College of Surgeons. Dr. Garely is also a senior oral board examiner for the American Board of Obstetrics and Gynecology. He has published numerous papers and book chapters and has lectured throughout the world.
Associate Director of Female Pelvic Medicine and Reconstructive Surgery at Mount Sinai South Nassau. She is an Assistant Professor in the Department of Obstetrics, Gynecology, and Reproductive Science.
She is Board Certified in both Obstetrics and Gynecology, and Female Pelvic Medicine and Reconstructive Surgery. She is a fellow of the American College of Obstetricians and Gynecologists and the American College of Surgeons.A Summa Cum Laude and Phi Beta Kappa graduate of Hunter College, Dr. Liberman obtained her medical degree from New York Medical College. She completed her residency at SUNY Stony Brook in Obstetrics and Gynecology.
Dr. Liberman did her fellowship in Urogynecology and Pelvic Reconstructive Surgery at Maimonides Medical Center.
Joanne is a Board Certified Family Nurse Practitioner. She earned her bachelor’s degree in nursing from the University of Florida, and master’s degree in Family Health from SUNY Downstate. She began her career in health care during her sophomore year of college by working as a certified nurse assistant at a small community hospital in Gainesville, Florida. Since then, she has accumulated seven years of clinical nursing experience and education at Mount Sinai medical Center in NYC. She is experienced in various areas of patient care (gastrointestinal, medical-surgical and obstetrics/gynecology).
Joanne is highly praised by our patients. She will assist in facilitating your care whether you opt for conservative management or surgical intervention. Her skills include pessary insertion, posterior tibial nerve stimulation (PTNS), urodynamics and post-operative care.
Female Pelvic Medicine and Reconstructive Surgery - Mount Sinai South Nassau
Assistant Clinical Professor of Obstetrics and Gynecology – The Mount Sinai School of Medicine
Dr. Rahimi is board certified in Obstetrics and Gynecology and a fellow of the American College of Obstetricians and Gynecologists. After obtaining her master of science from the Johns Hopkins School of Public Health, she earned her medical degree from Temple University School of Medicine. She then completed her residency in Obstetrics and Gynecology at Winthrop University Hospital and fellowship in Female Pelvic Reconstructive Surgery at Mount Sinai School of Medicine.
Alexandra is an ANCC Board Certified Nurse Practitioner. She earned her bachelor’s degree in nursing and master’s degree in adult-gerontology nursing from Adelphi University. Prior to joining us, Alexandra has worked as a nurse practitioner at Mount Sinai South Nassau and an acute care nurse practitioner at Northwell Health in Forest Hills. She has also worked as a registered nurse at St. Francis and Winthrop University Hospitals. Alexandra is a certified Advanced Cardiac Life Support Provider and Basic Life Support Provider by the American Heart Association.
Alexandra is a highly effective practitioner with a strong dedication to provide hands-on, quality patient care. She has comprehensive experience prescribing necessary medications, assessing and ordering appropriate tests, diagnoses, and appropriate treatments. She is bilingual in English and Russian, with some working knowledge of Hebrew.
If you answer "yes" to any of the following questions, Dr. Garely and his team can help:
-Do you ever leak urine when you cough, laugh, sneeze, exercise, run, or engage in sexual relations?
-Do you ever feel that you can not "delay" running to the bathroom?
-Do you ever find that if you don't get to the bathroom fast enough that you will have an accident?
-Do you wake up at night to urinate?
-Do you feel that you don't empty your bladder after urinating?
-Do you feel pressure in your vagina?
-Do you see or feel a bulge in the vagina or rectum?
-Did anyone ever tell you that your "bladder has dropped"?
-Did your physician tell you that you need surgery for incontinence or pelvic prolapse?
-Do you ever have to change positions or put your fingers in or around your vaginal area to help urinate or have a bowel movement?
Dr. Garely is one of the most experienced gynecologic surgeons in the country. Assuming that the hysterectomy is absolutely indicated, Dr. Garely will review surgical options and help you make the best choice tailored to your problem and perceptions.
Yes. Many physicians employ "rules" that ensure they only operate on extremely healthy patients. Dr. Garely knows that the "average" patient is not always thin, young, or without medical problems. Having trained and worked at some of the nations best medical centers, Dr. Garely is an expert in taking care of "high risk" patients. Working with the patients own primary care providers, Dr. Garely can usually prepare even the sickest and oldest patients for successful surgery when indicated. All of the hospitals that he operates at have specialists who help him manage complicated patients.
Yes. In almost every case other than laparoscopy, a spinal or epidural anesthesia can be used. This is always discussed prior to surgery and face-to-face consultation with the anesthesiologist can be arranged well in advance of the operation if indicated.
Yes. This is a perfect time for concurrent procedures. Patients only need one anesthesia, and operating room costs are usually significantly lower. Labial re-shaping, and vaginal tightening can be done by Dr. Garely. If "tummy tucks", liposuction, or breast surgery is desired, Dr. Garely can recommend some of the top plastic surgeons in the NY area to participate in the surgery. Insurance will usually cover a large part of the costs.
When the use of the robot is indicated, members of Dr. Garely's team are the most experienced in the tri-state area. Most patients are surprised to learn that robotic procedures usually take 2-3 times longer than straight laparoscopic surgery, often with more incisions. Robotic procedures can take 4-5 times longer than Dr. Garely's "mini-laparotomy" incision, with multiple small visible incisions on the abdomen compared to his one small incision right over the pubic bone. When consulting any surgeon who promises to do your surgery with the robot, be sure to ask how many cases they have done, and how long the average case will take. The most experienced pelvic surgeons in the world are able to do this type of surgery with minimally invasive techniques without subjecting our patients to the prolonged operative times associated with the robot, unless it is in the patients best interest.
We work as team in the Long Island office and it is never a problem if you would prefer to see Dr. Liberman or Dr. Rahimi. For many of our Russian or Farsi speaking patients this is actually encouraged. We want our patients to feel comfortable with the care they receive.
Dr. Garely is among the most experienced surgeons in the country for the treatment of mesh complications. He removes mesh on a weekly basis. Patients are referred into his New York practice from all over the country.
This depends on the type of surgery performed. In most cases, patients are discharged either on the day of surgery or within 24 hours. No one is "pushed" out of the hospital, and Dr. Garely can usually arrange for a visiting nurse to check on patients at home. Dr. Garely has a very low rate of post-operative infections. This is partly because patients leave the hospital quickly, decreasing the risk of picking up "hospital acquired infections".
Pelvic reconstructive surgery is very complicated. To maintain his high success rates, Dr. Garely does every major step of the operation himself. Residents and fellows participate in the operation, but his operating room is not a place where anyone "practices" on patients. Dr. Garely will "teach" during his operations, but this is done by demonstration, not trial and error. Residents and fellows are integral to the pre and post-operative care of patients. They are in the hospital 24 hours a day and are involved with the minute to minute care. None of Dr. Garely's assistants does anything without consulting with him first. Because of his association with the Icahn School of Medicine at Mount Sinai, Dr. Garely works closely with the Chairman of the Department (Dr. Brodman) and the Director of Gynecology (Dr. Ascher- Walsh), Dr. Garely has immediate access and coverage from two of the best surgeons in New York City.
No. Less than half of Dr. Garely's patients end up with a surgical procedure. Most patients can be successfully managed with medication or a pessary. Some patients are referred to physical therapists who specialize in pelvic floor disorders and incontinence treatment. Dr. Garely is committed to keeping patients out of the operating room. Unless it is absolutely indicated, Dr, Garely will never tell a patient that they "need" an operation.
No. This is a highly negotiable point. In some cases removal of part of the uterus can aid in the repair. Total removal of the uterus is rarely done, and then only in cases where there are abnormal cells or pre-cancer of the cervix. By preserving the lower part of the uterus and cervix, there is no cutting of the vagina, which significantly decreases complications during the repair. While it is not known whether removal of the cervix will impair sexual function, Dr. Garely errs on the side of conservatism, and takes no chances. Patients who desire future fertility will need special counseling to help them make important decisions.
No. It is currently recommended that patients under 65 keep their ovaries so that they don't increase their risk of heart disease. Taking into consideration each patients cancer history, cancer risk factors and family history, Dr. Garely can tailor a pre-operative plan that is acceptable to each patient. When accessible, the ovaries are visually inspected by Dr. Garely. If they appear abnormal, only then will they be removed.
Yes. Most mesh used in pelvic reconstructive surgery is made of a material called polypropylene. This is commonly called "Proline". Pelvic prolapse and incontinence is often caused because of a weakness or absence of normal muscle and ligaments. To compensate for these weaknesses, we need to use materials that can reconstruct or recreate the normal anatomy. We have tried to do this by using the patient’s own tissues. Unfortunately, this has resulted in high failure rates. In a quest to achieve better results, new formulations of Proline have been developed. This new material is very safe. These new mesh products are thinner, lighter, and less prone to cause complications. Complications include erosion (where the mesh finds its way into the vagina, bladder, or bowel), infection, pelvic pain, and pain during sexual relations. Research studies have shown that mesh placed through the vagina to fix vaginal prolapse has a much higher rate of complications than mesh applied through an abdominal or laparoscopic incision (often less than 1%). When considering the safety of any mesh product or procedure, the skill of the surgeon implanting the material is of paramount importance. Some of the finest surgeons in the world use vaginally applied mesh with low complication rates. Unfortunately, this is not easily taught, which is why there have been so many problems with transvaginal mesh.As a matter of practice, just to be safe, Dr. Garely usually will not use any mesh applied through a vaginal incision to correct prolapse. With years of experience, Dr. Garely is one of the country's foremost experts in the management of mesh complications.
Dr. Garely has 2 offices, one in Manhattan, and the other in Rockville Centre, Long Island.
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