Usage of third line therapies has increased from 1,822 in 2010 to a peak of 6,143 in 2013. NM cases logged peaked in 2013, the year of FDA approval for CD, and has since been declining. CD procedures increased each year after 2013, until declining in 2016 (Table 1). From 2010 to 2016, 5,499 case logs were submitted with 1,224 urologists logging a total of 26,874 NM and/or CD procedures, while only two urologists logged PTNS cases. Practitioners performed an average of 13.35 NM and 4.22 CD procedures per case log. Women performed more CD procedures than men (5.97 vs. 3.79, p=.001). FMPRS physicians performed significantly more procedures than physicians in all other specialty categories (p<.001). Similarly, urologists submitting cases for FMPRS certification performed more procedures than those submitting for initial certification or recertification (all comparisons p < .001). The majority of third line OAB therapies are being performed in large urban centers where >1,000,000 patients are served (33.4%, 41.5%, and 35.3% of NM, CD, and total cases) and in private practices (50.8%, 51.2%, and 50.9% of NM, CD, and total cases). Among the eight regions outlined by the American Urological Association, the Southeastern region had the most activity with respect to third line OAB procedures, containing 25.8% of urologists who submitted these cases and 26.4%, 23.6% and 25.8% of NM, CD, and total cases performed respectively. On a per-urologist bases, North Central urologists perform the most NM (16.23 cases/urologist), Northeastern urologists perform the most CD (8.45 cases/urologist), and North Central urologists perform the most total cases (20.69 cases/urologist). ANOVA revealed that region was predictive of variation in the number of NM and total cases performed, but not for the number of CD procedures performed.