With increasing age of the female population, the number of patients with pelvic floor disorders like overactive bladder syndrome, urinary stress incontinence, pelvic organ prolapse and fecal incontinence grows as well. These disorders are often chronical and cause significant morbidity, leading to a greater burden and costs on healthcare systems. The affected patients are mostly elderly and need more assessment time for care and therapy. To make the consultation hours of the urogynecologists more efficient one of the general nurses in the outpatient clinic has undergone further training in urotherapy. She supports the urogynecologists during their consultation time. The diagnosis are made by the urogynecologists and they assign the patient to advanced urotherapeutic counselling, when needed. Since 2013 the urotherapist has her own consultation time. Her work focuses on counselling, instructions and conservative therapies. 
Hypothesis: Chronic pelvic floor disorders can be managed and treated by a specialist nurse. Her integration in the assessement and guidance of these patients is supposed to improve efficiency and quality of care. Urogynecologists can be relieved in their consultation hours and can focus on more complex cases, surgery and teaching junior doctors. This concept of interprofessional teamwork might help stop the rise of health and economic costs for these patients. 
Aim of this study is to evaluate the workload of the urotherapist. As she became more busy with assigned patients the department authorities wanted to know more details of her work and it was decided to perform a prospective study. The activities of the urotherapist are documented, including the type of pelvic floor disorder and the type of counselling, the timeframe of the treatments and the patients’ satisfaction.

In this prospective observational study all activities of the urotherapist took place within the outpatient clinic of the Department of Obstetrics and Gynecology. From July 2016 to June 2018 the workload of the urotherapist was evaluated. For collecting patient data concerning diagnosis, treatment, consultation time of urogynecologist and the urotherapist and patient satisfaction a research project was set up. The project was approved by the local Ethic Committee. Included were female patients who consulted the urogynecologists and needed advanced counselling. Excluded were patients with comprehensive difficulties (language) or declined to complete the questionnaires. For data collection, we used questionnaires including the Australian Pelvic-floor Questionnaire, a short questionnaire for patients' satisfaction and hospital information systems. As the consultations by the urotherapist were established as a new service no comparison group was available. Hence, the outcome is descriptive only.

Between July 2016 and June 2018 about 1700 patients had contact with the urogynecologists, the urotherapist had contact with 514 (30%) of these patients. The following diagnosis were made by the urogynecologists: 215 cases (37%) with overactive bladder syndrome, chronic pelvic pain, recurrent urinary-tract infections ,157 cases (27%) with pelvic organ prolapse, 94 cases (16%) with urinary stress incontinence, 17 women (3%) with fecal incontinence/stool outlet syndrome and 100 cases (17%) with mixed disorders (not strictly urogynecological cases). 318/514 of these patients had contact with the urotherapist once or twice, 178 between 3 and 10 times, 11 between 11 and 20 times and 6 patients contacted the urotherapist more than 20 times. 
See Fig. 1.
The number of urotherapeutic consultations were overall 1555: 919 (59%) were counselling by phone, 252 (16%) personal counselling of in- and out-patients, 183 (12%) therapies like percutaneous tibial nerve stimulation (ptns) or fitting of pessaries, 88 (6%) urinary catheter management and 113 (6%) administrative support like filling in recipes.
38/514 urogynecological patients consented to participate in the whole prospective observational study and provided detailed information by filling in all the questionnaires. The diagnosis of theses 38 patients were as follows: overactive bladder, OAB, in 33 (57%) cases, pelvic organ prolapse, POP, in 9 (16%), urinary stress incontinence, USI, in 10 (17%), and fecal incontinence, FI, in 6 (10%) cases. Multiple diagnosis were possible. The corresponding mean age per diagnosis where 72 years for OAB, 75 years for POP, 72 years for USI and 69 years for patients with FI.
The mean consultation time of the urotherapist was 5.7 hours (0.5 – 35.8 hours), the mean consultation time of the urogynecologist 2.6 hours (0.5 – 10.8 hours). 
From a total of 215 consultation hours the urotherapist had 189 (88%) hours of personal contact with the patients and 27 (12%) hours contact mostly by phone (sometimes email). A personal consultation took 47 min on average, a consultation by phone 27 min on average. 
The activities of the urotherapist are summarized in Fig. 2. 
Patients' satisfaction with their therapy was good to very good in most cases, most of them would recommend the urotherapeutic service. 33/38 (87%) returned the questionnaire.

Chronic pelvic floor disorders can be managed and treated by a specialist nurse, the urotherapist. Counselling, giving instructions and conservative treatments are time-consuming activities. Patients with pelvic floor disorders show different levels of personal requirements. Individual care for each patient can vary widely from one consultation about incontinence pads or clarifying administrative issues pre- and postoperatively to intense therapies over weeks like ptns or bladder instillations. The integration of an urotherapist in the assessment and guidance of these patients improves efficiency and quality of care. The service of the urotherapist is highly appreciated by the patients. 
Urogynecologists are relieved in their workload in the outpatient clinic. They will have more time to focus on complex cases, surgery, teaching junior doctors and peri-and postoperative care as well. Our study could not answer the question if the concept of interprofessional teamwork has an impact on costs or not. This will be a future task. 
The study enabled us to not only continue but also further enlarge the schedule for the urotherapist. In addition, the results are a good basis to negotiate with the health insurances for covering, at least partly, the costs.

As people are getting older the frequency of chronic diseases are on the rise. To meet these new needs the concept of interprofessional teamwork was established. In urogynecology this can be implemented by integrating an urotherapist as a specialist nurse in the outpatient clinic.