0001603756-22-000011 | 10-K | XBRL Viewer

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Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets
Cash and cash equivalents	$ 220,878	$ 241,181
Accounts receivable, net of allowance for credit losses of $355 and $465 at December 31, 2021 and 2020, respectively	29,044	18,270
Inventory, net	64,946	63,060
Prepaid expenses and other current assets	6,449	5,435
Total current assets	321,317	327,946
Property and equipment, net	6,915	6,328
Intangible assets, net	106,469	196
Other assets	7,734	7,736
Goodwill	105,510	0
Total assets	547,945	342,206
Current liabilities
Accounts payable	7,654	10,660
Accrued liabilities	5,435	6,684
Accrued compensation and benefits	12,413	5,948
Operating lease liability, current portion	1,366	1,280
Debt, net of unamortized debt issuance costs, current portion	0	21,110
Total current liabilities	26,868	45,682
Operating lease liability, net of current portion	9,052	9,154
Deferred tax liabilities, net	19,217	0
Other long-term liabilities	10,370	0
Total liabilities	65,507	54,836
Commitments and contingencies (Note 4)
Stockholders’ equity
Preferred stock, par value $0.0001 per share; 10,000,000 shares authorized, no shares issued and outstanding at December 31, 2021 and 2020	0	0
Common stock, par value $0.0001 per share, 50,000,000 shares authorized at December 31, 2021 and 2020; 46,330,167 and 39,931,030 shares issued and outstanding at December 31, 2021 and 2020, respectively	5	4
Additional paid-in capital	803,559	522,296
Accumulated deficit	(314,566)	(234,499)
Accumulated other comprehensive loss	(6,560)	(431)
Total stockholders’ equity	482,438	287,370
Total liabilities and stockholders’ equity	$ 547,945	$ 342,206

Consolidated Balance Sheets - (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 355	$ 465
Preferred stock, par value (USD per share)	$ 0.0001	$ 0.0001
Preferred stock authorized (shares)	10,000,000	10,000,000
Preferred stock issued (shares)	0	0
Preferred stock outstanding (shares)	0	0
Common stock, par value (USD per share)	$ 0.0001	$ 0.0001
Common stock authorized (shares)	50,000,000	50,000,000
Common stock issued (shares)	46,330,167	39,931,030
Common stock outstanding (shares)	46,330,167	39,931,030

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Comprehensive Income [Abstract]
Net revenue	$ 24,100	$ 111,535	$ 13,820
Cost of goods sold	64,572	44,444	6,490
Gross profit	115,718	67,091	7,330
Operating expenses
Research and development	37,297	29,055	20,066
General and administrative	32,785	25,551	19,076
Sales and marketing	105,789	66,130	48,672
Amortization of intangible assets	7,241	115	115
Acquisition-related costs	4,414	0	0
Total operating expenses	187,526	120,851	87,929
Loss from operations	(71,808)	(53,760)	(80,599)
Other income (expense)
Interest income	40	761	2,974
Loss on disposal of property and equipment	(91)	(41)	0
Interest and other expense	(7,426)	(1,874)	(2,309)
Other (expense) income, net	(7,477)	(1,154)	665
Loss before income tax expense	(79,285)	(54,914)	(79,934)
Income tax expense	782	1	1
Net loss	(2,800)	(54,915)	(79,935)
Foreign currency translation adjustment	(6,129)	(3)	(12)
Comprehensive loss	$ (86,196)	$ (54,918)	$ (79,947)
Net loss per share, basic (USD per share)	$ (1.86)	$ (1.48)	$ (2.80)
Net loss per share, diluted (USD per share)	$ (1.86)	$ (1.48)	$ (2.80)
Weighted-average shares used to compute basic net loss per share (shares)	43,072,298	36,981,335	28,567,302
Weighted-average shares used to compute diluted net loss per share (shares)	43,072,298	36,981,335	28,567,302

Consolidated Statements of Stockholders’ Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss
Balance at beginning of period (shares) at Dec. 31, 2018		27,806,934
Balance at beginning of period at Dec. 31, 2018	$ 143,275	$ 3	$ 243,337	$ (99,649)	$ (416)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for employee stock option exercises for cash (shares)		281,744
Issuance of common stock for employee stock option exercises for cash	506		506
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation (in shares)		613,717
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation	7,655		7,655
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation	1,065		1,065
Follow-on offering - issuance, less offering costs (shares)		5,345,000
Follow-on offering - issuance, less closing costs	110,449		110,449
Issuance of common stock for acquisition of Contura Limited	0
Issuance of common stock for warrant exercise (shares)		63,600
Issuance of common stock for warrant exercise	0
Foreign currency translation adjustment	(12)				(12)
Net loss	(79,935)			(79,935)
Balance at end of period (shares) at Dec. 31, 2019		34,110,995
Balance at end of period at Dec. 31, 2019	183,003	$ 3	363,012	(179,584)	(428)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for employee stock option exercises for cash (shares)		767,792
Issuance of common stock for employee stock option exercises for cash	3,703		3,703
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation (in shares)		405,907
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation	11,792		11,792
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation (shares)		46,336
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation	3,303		3,303
Follow-on offering - issuance, less offering costs (shares)		4,600,000
Follow-on offering - issuance, less closing costs	140,487	$ 1	140,486
Issuance of common stock for acquisition of Contura Limited	0
Foreign currency translation adjustment	(3)				(3)
Net loss	$ (54,915)			(54,915)
Balance at end of period (shares) at Dec. 31, 2020	39,931,030	39,931,030
Balance at end of period at Dec. 31, 2020	$ 287,370	$ 4	522,296	(234,499)	(431)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for employee stock option exercises for cash (shares)		522,495
Issuance of common stock for employee stock option exercises for cash	6,757		6,757
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation (in shares)		520,411
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation	17,793		17,793
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation (shares)		169,054
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation	7,371		7,371
Follow-on offering - issuance, less offering costs (shares)		4,025,000
Follow-on offering - issuance, less closing costs	189,978	$ 1	189,977
Issuance of common stock for acquisition of Contura Limited (in shares)		1,096,583
Issuance of common stock for acquisition of Contura Limited	55,728		55,728
Issuance of common stock for intangible asset (in shares)		65,594
Issuance of common stock for exclusive license asset	3,637		3,637
Foreign currency translation adjustment	(6,129)				(6,129)
Net loss	$ (2,800)			(80,067)
Balance at end of period (shares) at Dec. 31, 2021	46,330,167	46,330,167
Balance at end of period at Dec. 31, 2021	$ 482,438	$ 5	$ 803,559	$ (314,566)	$ (6,560)

Consolidated Statements of Stockholders' Equity (Parenthetical) - Common Stock - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Follow-on offering - issuance, less offering costs (shares)	4,025,000	4,600,000	5,345,000
Stock issuance price (USD per share)	$ 50.00	$ 32.50	$ 22.00
Stock issuance - offering costs	$ 11,272	$ 9,013	$ 7,141

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash Flows from Operating Activities
Net loss	$ (80,067)	$ (54,915)	$ (79,935)
Adjustments to reconcile net loss to net cash used in operating activities
Depreciation and amortization	9,126	1,741	1,191
Loss on disposal of property and equipment	91	41	0
Stock-based compensation	25,164	15,095	8,720
Amortization of debt issuance costs	4,991	774	873
(Reversal of) provision for allowance of credit losses	(122)	390	75
Change in fair value of contingent consideration	2,740	0	0
Deferred income taxes and other items, net	582	165	0
Changes in operating assets and liabilities, net of business acquisition
Accounts receivable	(8,998)	(10,781)	(7,527)
Inventory	(1,108)	(47,353)	(11,986)
Prepaid expenses and other current assets	(940)	(863)	(752)
Other assets	(225)	(90)	(299)
Accounts payable	(2,862)	4,778	2,446
Accrued liabilities	(1,976)	4,193	1,155
Accrued compensation and benefits	6,155	2,573	2,711
Lease liability	143	510	(126)
Net cash used in operating activities	(47,306)	(83,742)	(83,454)
Cash Flows from Investing Activities
Purchases of property and equipment	(2,261)	(2,938)	(1,339)
Acquisition of a business, net of cash acquired	(140,741)	0	0
Purchases of short-term investments	0	0	(36,404)
Proceeds from sales and maturities of short-term investments	0	12,592	83,030
Net cash (used in) provided by investing activities	(143,002)	9,654	45,287
Cash Flows from Financing Activities
Payment of debt issuance costs	(106)	0	0
Proceeds from debt	75,000	0	0
Repayment of debt	(101,116)	0	0
Proceeds from exercise of stock options	6,757	3,703	506
Net cash provided by financing activities	170,513	144,190	110,955
Effect of exchange rate changes on cash and cash equivalents	(508)	(3)	(12)
Net (decrease) increase in cash and cash equivalents	(20,303)	70,099	72,776
Cash and cash equivalents, beginning of year	241,181	171,082	98,306
Cash and cash equivalents, end of year	220,878	241,181	171,082
Supplemental Disclosure of Cash Flow Information
Cash paid for interest	2,178	1,102	1,436
Cash paid for taxes	1	1	1
Noncash Investing and Financing Activities
Common stock issuance for business acquisition	55,728	0	0
Contingent consideration for business acquisition	7,630	0	0
Common stock issuance for exclusive license asset	3,637	0	0
Accrued loan fees as debt issuance costs	4,500	0	0
Common Stock
Cash Flows from Financing Activities
Payment of common stock offering costs upon follow-on public offering	(11,272)	(9,013)	(7,141)
Follow-on Offering
Cash Flows from Financing Activities
Proceeds from offering of common stock upon follow-on public offering	201,250	149,500	117,590
Follow-on Offering \| Common Stock
Cash Flows from Financing Activities
Payment of common stock offering costs upon follow-on public offering	$ (11,272)	$ (9,013)	$ (7,141)

Nature of Operations and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Nature of Operations and Summary of Significant Accounting Policies

Nature of Operations

Axonics, Inc. (the Company) was incorporated in the state of Delaware on March 2, 2012 under the name American Restorative Medicine, Inc. In August 2013, the Company changed its name to Axonics Modulation Technologies, Inc. In March 2021, the Company changed its name to Axonics, Inc. The Company had no operations until October 1, 2013, when the license agreement between Alfred E. Mann Foundation for Scientific Research (AMF) and the Company (the License Agreement) was entered into. The Company is a medical technology company that develops and commercializes innovative and minimally invasive products to treat bladder and bowel dysfunction. The Company has designed and developed the rechargeable sacral neuromodulation (SNM) system (r-SNM System), which delivers mild electrical pulses to the targeted sacral nerve in order to restore normal communication to and from the brain to reduce the symptoms of overactive bladder (OAB), urinary retention (UR) and fecal incontinence (FI). The r-SNM System is protected by intellectual property based on Company-generated innovations and patents and other intellectual property licensed from AMF. The Company has marketing approvals in the United States, Europe, Canada, and Australia for all relevant clinical indications. The premarket approval (PMA) application for the r-SNM System for the treatment of FI was approved by the U.S. Food and Drug Administration (FDA) on September 6, 2019, and the PMA application for the r-SNM System for the treatment of OAB and UR was approved by the FDA on November 13, 2019. Accordingly, the Company began U.S. commercialization of its r-SNM System in the fourth quarter of 2019. Prior to the fourth quarter of 2019, the Company derived revenue only from its international operations in select markets including England, the Netherlands and Canada, and its activities had consisted primarily of developing the r-SNM System, conducting its RELAX-OAB post-market clinical follow-up study in Europe, its ARTISAN-SNM pivotal clinical study in the United States and hiring and training its U.S. commercial team in preparation for the launch of the r-SNM System in the United States. Beginning in February 2021 with the acquisition of Contura Limited, the Company also markets Bulkamid, a urethral bulking agent to treat female stress urinary incontinence (SUI). For more information, see Note 9.

November 2019 Follow-On Offering

On November 22, 2019, the Company completed a follow-on offering by issuing 5,345,000 shares of common stock, at an offering price of $22.00 per share, inclusive of 750,000 shares of the Company’s common stock issued upon the exercise by the underwriters of their option to purchase additional shares. The net proceeds to the Company were approximately $110.4 million, after deducting underwriting discounts, commissions and offering expenses payable by the Company.

May 2020 Follow-On Offering

On May 12, 2020, the Company completed a follow-on offering by issuing 4,600,000 shares of common stock, at an offering price of $32.50 per share, inclusive of 600,000 shares of the Company’s common stock issued upon the exercise by the underwriters of their option to purchase additional shares. The net proceeds to the Company were approximately $140.5 million, after deducting underwriting discounts, commissions and offering expenses payable by the Company.

May 2021 Follow-On Offering

On May 14, 2021, the Company completed a follow-on offering by issuing 4,025,000 shares of common stock, at an offering price of $50.00 per share, inclusive of 525,000 shares of the Company’s common stock issued upon the exercise by the underwriters of their option to purchase additional shares. The net proceeds to the Company were approximately $190.0 million, after deducting underwriting discounts, commissions and offering expenses payable by the Company.

Principles of Consolidation

The accompanying consolidated financial statements include the accounts of the Company, its wholly-owned subsidiaries, Axonics Europe, S.A.S., Axonics Modulation Technologies U.K. Limited, Axonics Modulation

Technologies Australia Pty Ltd, Axonics Women’s Health Limited, Bulkamid SARL, Axonics GmbH, and Contura, Inc. Intercompany accounts and transactions have been eliminated in consolidation.

Basis of Presentation

The accompanying consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States (GAAP). Certain prior year reported amounts have been reclassified to conform with the 2021 presentation.

COVID-19

The recent COVID-19 outbreak, and the resulting restrictions intended to slow the spread of COVID-19, including stay-at-home orders, business shutdowns and other restrictions, has adversely affected the Company’s business in several ways. The primary impact on the Company’s business was the cancellation or delay of elective procedures in certain areas to allow health care facilities to prioritize the treatment of COVID-19 patients during the initial stages and resurgence periods of the pandemic or because patients are avoiding health care facilities that they feel are unsafe. These developments materially reduced the number of procedures using the Company’s r-SNM System. If governmental authorities recommend again in the future that it is deemed advisable for health care facilities to not perform outpatient elective procedures, as was the case at various times throughout 2020 and 2021, the Company expects it would materially harm the Company’s revenues and potentially increase the Company’s operating loss. Even as efforts to contain the pandemic have made progress and some restrictions have relaxed, new variants of the virus may continue to cause additional outbreaks. These challenges will likely continue for the duration of the pandemic and could reduce our revenue and negatively impact our business, financial condition and results of operations while the pandemic continues. If these delays in procedures occur in the future, the Company may have to scale back its business, including reducing headcount, which could have a negative impact on the Company’s long-term operations. The Company could also experience other negative impacts of the COVID-19 outbreak such as the lack of availability of the Company’s key personnel, temporary closures of the Company’s office or the facilities of the Company’s business partners, customers, third party service providers or other vendors, and the interruption of the Company’s supply chain, distribution channels, liquidity and capital or financial markets.

Any disruption and volatility in the global capital markets as a result of the pandemic may increase the Company’s cost of capital and adversely affect the Company’s ability to access financing when and on terms that the Company desires. In addition, a recession resulting from the spread of COVID-19 could materially affect the Company’s business, especially if a recession results in higher unemployment causing potential patients to not have access to health insurance.

The ultimate extent to which the COVID-19 pandemic and its repercussions impact the Company’s business will depend on future developments, which are highly uncertain. However, the foregoing and other continued disruptions to the Company’s business as a result of COVID-19 could result in a material adverse effect on the Company’s business, results of operations, financial condition and cash flows.

Use of Estimates

The preparation of consolidated financial statements in conformity with GAAP requires the Company’s management to make estimates and judgments that affect the reported amounts of assets, liabilities, and expenses, and related disclosure of contingent assets and liabilities. The Company bases its estimates on historical experience and on various other assumptions that it believes to be reasonable under the circumstances. The results of this evaluation then form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates and such differences may be material to the consolidated financial statements.

Revenue Recognition

Revenue recognized during the years ended December 31, 2021, 2020, and 2019 relates entirely to the sale of the Company’s products to its customers and distributors.

The Company has revenue arrangements that consist of a single performance obligation. The Company recognizes revenue at the point in time when it transfers control of promised goods to its customers. Revenue is measured as the amount of consideration it expects to receive in exchange for transferring goods. The amount of

revenue that is recognized is based on the transaction price, which represents the invoiced amount and includes estimates of variable consideration such as discounts, where applicable. The Company also sells to distributors and applies the same policies as its revenue arrangements with customers, specifically that revenue is recognized at the point in time when it transfers control of promised goods to its distributors, revenue is measured as the amount of consideration it expects to receive in exchange for transferring goods, the amount of revenue that is recognized is based on the transaction price, which represents the invoiced amount and includes estimates of variable consideration such as discounts, where applicable. The Company does not offer rights of return or price protection. The amount of variable consideration included in the transaction price may be constrained and is included only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized under the contract will not occur in a future period. Payment terms, typically less than three months, do not include a significant financing component. The Company extends credit to its customers and distributors based upon an evaluation of their financial condition and credit history and generally requires no collateral. The Company does not have any contract balances related to product sales. The Company also does not have significant contract acquisition costs related to product sales.

In accordance with Company policy and based on the Company’s historical experience, the allowance for product returns was $0.2 million and $0.3 million at December 31, 2021 and 2020, respectively. Damaged or defective products are replaced at no charge under the Company’s standard warranty. For the years ended December 31, 2021, 2020, and 2019, the replacement costs were $0.2 million, $0.1 million, and minimal, respectively.

The Company offers its standard warranty to all customers. The Company does not sell any warranties on a standalone basis. The Company’s warranty provides that its products are free of material defects and conform to specifications, and includes an offer to repair, replace or refund the purchase price of defective products. This assurance does not constitute a service and is not considered a separate performance obligation. The Company estimates warranty liabilities at the time of revenue recognition and records it as a charge to operating expenses. The warranty liability as of December 31, 2021 and 2020 were $0.1 million and $0.1 million, respectively.

Shipping and handling costs incurred for the delivery of goods to customers and distributors are included in cost of goods sold. Amounts billed to customers and distributors for shipping and handling are included in net revenue.

The following table provides additional information pertaining to net revenue disaggregated by product and geographic market for the years ended December 31, 2021, 2020, and 2019 (in thousands):


	Years Ended December 31,
	2021		2020		2019
SNM net revenue
United States	$	153,837	$	107,542	$	8,376
International markets	3,753		3,993		5,444
	$	157,590	$	111,535	$	13,820
Bulkamid net revenue
United States	$	12,660	$	—	$	—
International markets	10,040		—		—
	$	22,700	$	—	$	—
Total net revenue	$	180,290	$	111,535	$	13,820

Allowance for Credit Losses

The Company makes estimates of the collectability of accounts receivable in accordance with ASU 2016-13. The Company’s estimate of future losses is made by management based upon historical bad debts, customer receivable balances, age of customer receivable balances, customers’ financial conditions and reasonable forecasted economic trends. Despite the Company’s efforts to minimize credit risk exposure, customers could be adversely affected if future economic and industry trends, including those related to COVID-19, change in such a

manner as to negatively impact their cash flows. The full effects of COVID-19 on the Company’s customers are highly uncertain and cannot be predicted. As a result, the Company’s future collection experience can differ significantly from historical collection trends. If the Company’s customers experience a negative impact on their cash flows, it could have a material adverse effect on the Company’s results of operations and financial condition.

The following table summarizes the changes in our allowance for credit losses (in thousands):


	Years Ended December 31,
	2021		2020		2019
Balance at beginning of period	$	465	$	75	$	—
Write-offs	12		—		—
Bad debt (recoveries) expense	(122)		390		75
Balance at end of period	$	355	$	465	$	75

Cash and Cash Equivalents

Cash equivalents consist of short-term, highly liquid investments purchased with an original maturity of three months or less. Financial instruments that potentially subject the Company to a concentration of credit risk consist of cash and cash equivalents. At times, the cash and cash equivalent balances may exceed federally insured limits. The Company does not believe that this results in any significant credit risk as the Company’s policy is to place its cash and cash equivalents in highly rated financial institutions.

Fair Value of Financial Instruments

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. A three-level fair value hierarchy prioritizes the inputs used to measure fair value. The hierarchy requires entities to maximize the use of observable inputs and minimize the use of unobservable inputs. The three levels of inputs used to measure fair value are as follows:

•Level 1: Inputs are unadjusted quoted prices in active markets for identical assets or liabilities.

•Level 2: Inputs are quoted prices for similar assets and liabilities in active markets or quoted prices for identical or similar instruments in markets that are not active and model-derived valuations in which all significant inputs and significant value drivers are observable in active markets.

•Level 3: Inputs are unobservable inputs based on the Company’s assumptions and valuation techniques used to measure assets and liabilities at fair value. The inputs require significant management judgment or estimation. The Company’s assessment of the significance of an input to the fair value measurement requires judgment, which may affect the valuation of fair value assets and liabilities and their placement within the fair value hierarchy levels. The carrying amounts reported in the consolidated financial statements approximate the fair value for cash and cash equivalents, accounts receivable, accounts payables, and accrued expenses, due to their short-term nature. The carrying amount of the Company’s term loan, which is described below, approximates fair value, considering the interest rates are based on the prime interest rate.

The purchase price of business acquisitions is primarily allocated to the tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values on the acquisition date, with the excess recorded as goodwill.

Contingent consideration represents contingent milestone, performance and revenue-sharing payment obligations related to acquisitions and is measured at fair value, based on significant inputs not observable in the market, which represents a Level 3 measurement within the fair value hierarchy. The valuation of contingent consideration is estimated using a binary option-based approach with assumptions the Company believes would be made by a market participant. Significant inputs include projected revenues, discount rates, volatility factors and risk-free rates. The Company assesses these assumptions on an ongoing basis as additional data impacting the assumptions is obtained and any change in fair value of the contingent consideration is recorded in the consolidated

statements of comprehensive loss. Significant increases or decreases in any of those inputs in isolation would result in a significantly lower or higher fair value measurement. Generally, a change in the assumption used for the projected revenues would result in a directionally similar change to the overall estimate of the contingent consideration. The fair value of contingent consideration of $10.4 million at December 31, 2021 is reflected in other long-term liabilities on the Company’s consolidated balance sheets with the change in fair value of $2.7 million during the year ended December 31, 2021 reflected in general and administrative expenses in the consolidated statements of comprehensive loss.

The following table summarizes the changes in the fair value of recurring Level 3 fair value measurements during the year ended December 31, 2021 (in thousands):




Liabilities
Contingent consideration:
December 31, 2020	$	—
February 25, 2021 Acquisition	7,630
Change in fair value included in earnings	2,740
December 31, 2021	$	10,370

There were no transfers between Levels 1, 2 or 3 for the periods presented.

Investment Securities

Those investments in debt securities with maturities less than 12 months at the date of purchase are considered short-term investments. Those investments in debt securities with maturities greater than 12 months at the date of purchase are considered long-term investments. The Company’s investment securities classified as available-for-sale are recorded at fair value based on the fair value hierarchy (Level 1 and Level 2 inputs in the fair value hierarchy), and consists primarily of commercial paper, corporate notes and U.S. government and agency securities. Unrealized gains or losses, deemed temporary in nature, are reported as other comprehensive income within the consolidated statement of comprehensive income (loss). There were no unrealized gains or losses during the years ended December 31, 2021, 2020, and 2019.

A decline in the fair value of any security below cost that is deemed other than temporary results in a charge to net income (loss) and the corresponding establishment of a new cost basis for the security. Premiums (discounts) are amortized (accreted) over the life of the related security as an adjustment to yield using the straight-line interest method. Dividend and interest income are recognized when earned. Realized gains or losses are included in net income (loss) and are derived using the specific identification method for determining the cost of securities sold.

The Company had no outstanding investment securities as of December 31, 2021 and 2020.

Foreign Currency Translation

The functional currencies of the Company’s subsidiaries are currencies other than the U.S. dollar. The Company translates assets and liabilities of the foreign subsidiaries into U.S. dollars at the exchange rate in effect on the balance sheet date. Revenue and expenses of the subsidiaries are translated into U.S. dollars at the average exchange rate during the period. Gains or losses from these translation adjustments are reported as a separate component of stockholders’ equity in accumulated other comprehensive gain or loss until there is a sale or complete or substantially complete liquidation of the Company’s investment in the foreign subsidiary at which time the gains or losses will be realized and included in net income (loss). As of December 31, 2021 and 2020, all foreign currency translation gains (losses) have been unrealized and included in accumulated other comprehensive loss. Accumulated other comprehensive loss consists entirely of losses or gains from translation of foreign subsidiaries at December 31, 2021 and 2020.

Inventory, Net

Inventories are stated at the lower of cost or net realizable value, with cost computed on a first-in, first-out basis. The Company reduces the carrying value of inventories for items that are potentially excess, obsolete, or slow-moving based on changes in customer demand, technology developments, or other economic factors.

The Company capitalizes inventory produced for commercial sale. The Company capitalizes manufacturing costs as inventory following both the receipt of regulatory approval from regulatory bodies and the Company’s intent to commercialize. Costs associated with developmental products prior to satisfying the Company’s inventory capitalization criteria are charged to research and development expense as incurred.

Products that have been approved by certain regulatory authorities may also be used in clinical programs to assess the safety and efficacy of the products for usage that have not been approved by the FDA or other regulatory authorities. The form of product utilized for both commercial and certain clinical programs that are identical are included as inventory with an “alternative future use” as defined in authoritative guidance. Component materials and purchased products associated with clinical development programs are included in inventory and charged to research and development expense when the product enters the research and development process and no longer can be used for commercial purposes and, therefore, does not have an “alternative future use.”

For products that are under development and have not yet been approved by regulatory authorities, purchased component materials are charged to research and development expense when the inventory ownership transfers to the Company.

The Company analyzes inventory levels to identify inventory that may expire prior to sale, inventory that has a cost basis in excess of its net realizable value, or inventory in excess of expected sales requirements. Although the manufacturing of the r-SNM System is subject to strict quality control, certain batches or units of product may no longer meet quality specifications or may expire, which would require adjustments to the Company’s inventory values. The Company also applies judgment related to the results of quality tests that are performed throughout the production process, as well as the understanding of regulatory guidelines, to determine if it is probable that inventory will be saleable. These quality tests are performed throughout the pre- and post-production processes, and the Company continually gathers information regarding product quality for periods after the manufacturing date. The Company’s products currently have a maximum estimated shelf-life range of 12 to 36 months and based on sales forecasts, the Company expects to realize the carrying value of the product inventory. In the future, reduced demand, quality issues, or excess supply beyond those anticipated by management may result in a material adjustment to inventory levels, which would be recorded as an increase to cost of sales.

The determination of whether inventory costs will be realizable or not requires estimates by the Company’s management. A critical input in this determination is future expected inventory requirements based on internal sales forecasts. Management then compares these requirements to the expiry dates of inventory on hand. To the extent that inventory is expected to expire prior to being sold, management will write down the value of inventory.

As of December 31, 2021, the Company had $46.8 million, $2.8 million, and $15.3 million of finished goods inventory, work-in-process inventory and raw materials inventory, respectively, net of reserves of $0.2 million. As of December 31, 2020, the Company had $42.1 million, $3.5 million and $17.5 million of finished goods inventory, work-in-process inventory and raw materials inventory, respectively. Reserves were de minimis as of December 31, 2020.

Customer and Vendor Concentration

As of December 31, 2021 and 2020, there were no customers who accounted for over 10% of the Company’s consolidated accounts receivable. As of December 31, 2021 and 2020, there was no vendor and one vendor, respectively, who accounted for over 10% of the Company’s consolidated accounts payable. As of December 31, 2021, 2020, and 2019, there were no customers who accounted for over 10% of the Company’s consolidated net revenue. As of December 31, 2021, 2020, and 2019, there were three, two, and three vendors, respectively, who accounted for over 10% of the Company’s inventory-related purchases.

Property and Equipment

Property and equipment are stated at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the assets, generally between three and seven years. Leasehold improvements are amortized over the lesser of the life of the lease or the useful life of the improvements. Maintenance and repairs are charged to expense as incurred. When assets are retired or otherwise disposed of, the cost and accumulated depreciation are removed from the balance sheet and any resulting gain or loss is reflected in operations.

Goodwill

Goodwill represents the excess purchase price over the fair values of the identifiable assets acquired less the liabilities assumed. Goodwill is tested for impairment at the reporting unit level by comparing the reporting unit’s carrying amount to the fair value of the reporting unit. The fair values are estimated using an income and discounted cash flow approach. The Company evaluates its goodwill on an annual basis in the fourth quarter or more frequently if it believes indicators of impairment exist. The Company assesses qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount or performs an annual impairment test. When tested quantitatively, the Company compares the fair value of the applicable reporting unit with its carrying value. In making this assessment, management relies on a number of factors, including expected future operating results, business plans, economic projections, anticipated future cash flows, business trends and declines in the Company’s market capitalization. The Company estimates the fair values of its reporting unit using a combination of the discounted cash flow (DCF) and income approaches. If the carrying amount of a reporting unit exceeds the reporting unit’s fair value, the amount by which the carrying value exceeds the fair value is recognized as an impairment loss. During the year ended December 31, 2021, the Company did not record any impairment charges related to goodwill.

Intangible Assets

Patent license asset

The intangible asset represents exclusive rights to an additional field-of-use on the patent suite within the License Agreement with AMF. The additional field-of-use was provided in exchange for 50,000 shares of Series A preferred stock, the fair value of which was $1.0 million in 2013. The intangible asset was recorded at its fair value of $1.0 million at the date contributed. In connection with the IPO, such shares of Series A preferred stock were converted into common stock. Amortization of this asset is recorded over the shorter of the patent or legal life on a straight-line basis. The weighted-average amortization period is 8.71 years. The Company will review the intangible asset for impairment whenever an impairment indicator exists. There have been no intangible asset impairment charges to date. For additional information, see Note 3.

Exclusive license asset

The intangible asset represents exclusive rights of existing technologies and development services from MST entered into on March 2, 2021. The agreement was provided in exchange for 65,594 shares of common stock, $0.0001 par value, the fair value of which was $3.6 million upon transfer. The intangible asset was recorded at its fair value of $3.3 million at the date of the agreement, with the difference of $0.3 million recorded as a vendor credit in accounts payable in the consolidated balance sheets. Amortization of this asset is recorded over the four-year term of the agreement on a straight-line basis. The Company will review the intangible asset for impairment whenever an impairment indicator exists. There have been no intangible asset impairment charges to date. For additional information, see Note 3.

Contura acquisition

The intangible assets represent technology, trade names and trademarks, and customer relationships acquired from Contura on February 25, 2021. The straight-line method over the period of estimated benefit is used to amortize finite-lived intangible assets except for customer relationships. Accounting Standards Codification (ASC) 350-30-35-3 states that customer relationships generally dissipate at a more rapid rate in the earlier periods following a company’s succession to these relationships, with the rate of attrition declining over time. As such, the accelerated method is used to amortize customer relationships. For additional information, see Notes 3 and 9.

Impairment of Long-Lived Assets

The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability is measured by comparing the carrying amount to the future net cash flows that the assets are expected to generate. If said assets are considered to be impaired, the impairment that would be recognized is measured by the amount by which the carrying amount of the assets exceeds the projected discounted future net cash flows arising from the asset. There have been minimal impairments of long-lived assets to date.

Leases

In accordance with Accounting Standards Update (ASU) No. 2016-02, “Leases (Topic 842)”, components of a lease should be split into three categories: lease components, non-lease components, and non-components. The fixed and in-substance fixed contract consideration (including any consideration related to non-components) must be allocated based on the respective relative fair values to the lease components and non-lease components. Entities may elect not to separate lease and non-lease components. Rather, entities would account for each lease component and related non-lease component together as a single lease component. The Company has elected to account for lease and non-lease components together as a single lease component for all underlying assets and allocate all of the contract consideration to the lease component only. Topic 842 allows for the use of judgment in determining whether the assumed lease term is for a major part of the remaining economic life of the underlying asset and whether the present value of lease payments represents substantially all of the fair value of the underlying asset. The Company applies the bright line thresholds referenced in Topic 842 to assist in evaluating leases for appropriate classification between operating and finance leases. The aforementioned bright lines are applied consistently to the Company’s entire portfolio of leases.

Operating lease ROU asset and operating lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. As the Company’s leases do not provide an implicit rate, the Company uses its incremental borrowing rate, which is the rate for a fully collateralized amortizing loan with the same maturity as the lease term, based on the information available at commencement date in determining the present value of future payments. The operating lease ROU asset also includes any lease payments made and excludes lease incentives and initial direct costs incurred. The lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise that option. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term.

Research and Development

Research and development costs are charged to operations as incurred. Research and development costs include salary and personnel-related costs, costs of clinical studies and testing, supplies and materials, and outside consultant costs.

Advertising Expense

The Company expenses advertising costs as they are incurred. During the years ended December 31, 2021, 2020, and 2019, advertising expense totaled $7.8 million, $2.9 million and $2.6 million, respectively, and are recorded within the sales and marketing expenses in its consolidated statements of comprehensive loss.

Income Taxes

The Company accounts for income taxes using the asset and liability method to compute the difference between the tax basis of assets and liabilities and the related financial amounts, using currently enacted tax rates. The Company has net deferred tax assets in certain jurisdictions. The realization of these deferred tax assets is dependent upon the Company’s ability to generate sufficient taxable income in future years. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount that more likely than not will be realized. The Company evaluates the recoverability of the deferred tax assets annually and maintains a full valuation allowance on its U.S. net deferred tax assets. The Company recognizes the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. The Company is subject to transfer pricing and other tax regulations designed to ensure that appropriate levels of income are reported as earned by the Company’s U.S. and foreign entities and are taxed accordingly. In the normal course of business, the Company is audited by federal, state and foreign tax authorities, and subject to inquiries from those tax authorities regarding the amount of taxes due. These inquiries may relate to the timing and amount of deductions and the allocation of income among various tax jurisdictions. The Company’s policy is to recognize interest and penalties related to unrecognized tax benefits, if any, in income tax expense.

Stock-Based Compensation

The Company measures the cost of employee and non-employee services in exchange for an award of equity instruments based on the grant-date fair value of the award and recognizes compensation cost over the requisite service period (typically the vesting period), generally four years. Forfeitures are estimated at the time of the grant and revised in subsequent periods to reflect differences between the estimates and the number of shares that actually become exercisable. The Company uses the Black-Scholes option pricing model to determine the fair value of stock options (as of the date of grant) that have service conditions for vesting. Stock options and restricted shares awards vest based on service conditions, typically over four years.

The Company also grants shares of performance-based restricted stock units that typically vest after one year only if the Company has also achieved certain performance objectives as defined and approved by the Company’s board of directors. The fair value of performance awards are determined based on the Company’s stock price at the date of grant and expensed over the performance period based on the probability of achieving the performance objectives. In addition, the Company also grants market-based restricted stock units that have combined market conditions and service conditions for vesting, for which the Company uses the Monte Carlo valuation model to value equity awards (as of the date of grant).

Net Loss per Share of Common Stock

Basic net loss per share of common stock is calculated by dividing the net loss attributable to common stockholders by the weighted-average number of shares of common stock outstanding during the period, without consideration for potentially dilutive securities. Diluted net loss per share is computed by dividing the net loss attributable to common stockholders by the weighted-average number of shares of common stock and potentially dilutive securities outstanding for the period. For purposes of the diluted net loss per share calculation, common stock options, unvested RSAs and RSUs are considered to be potentially dilutive securities. Because the Company has reported a net loss in all periods presented, diluted net loss per share of common stock is the same as basic net loss per share of common stock for those periods.

For the years ended December 31, 2021, 2020, and 2019, there were 2,444,444, 2,300,982, and 1,737,430 potentially dilutive weighted-average shares, respectively, that were not included in the computation of diluted weighted-average shares of common stock and common stock equivalent shares outstanding because their effect would have been antidilutive given the Company’s net loss.

Segment Reporting

Operating segments are defined as components of an entity for which separate financial information is available and that is regularly reviewed by the Chief Operating Decision Maker (CODM) in deciding how to allocate resources to an individual segment and in assessing performance. The Company’s CODM is its Chief Executive Officer. The Company has determined it operates in one segment, the development and

commercialization of innovative and minimally invasive products to treat bladder and bowel dysfunction. Geographically, the Company sells over 90% to hospitals in the United States. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance.

Recently Adopted Accounting Pronouncements

In December 2019, the Financial Accounting Standards Board (FASB) issued ASU 2019-12, “Income Taxes—Simplifying the Accounting for Income Taxes,” which simplifies the accounting for income taxes by clarifying and amending existing guidance related to the recognition of franchise tax, the evaluation of a step-up in the tax basis of goodwill and the effects of enacted changes in tax laws or rates in the effective tax rate computation, among other clarifications. This guidance is effective for annual periods beginning after December 15, 2020, which was the Company’s first quarter of fiscal year 2021, with early adoption permitted. The adoption of this guidance did not have an impact on the Company’s consolidated financial statements or related disclosures.

Recent Accounting Pronouncements

We have reviewed and considered all recent accounting pronouncements that have not yet been adopted and believe there are none that could potentially have a material impact on our business practices, financial condition, results of operations, or disclosures.

Property and Equipment

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Property and Equipment

Property and equipment, net consists of the following (in thousands) at:


	December 31,
	2021		2020
Equipment	$	2,429	$	1,205
Computer hardware and software	2,450		2,286
Tools and molds	1,579		1,404
Leasehold improvements	4,372		3,759
Furniture and fixtures	1,502		1,360
Construction in progress	127		129
	12,459		10,143
Less: accumulated depreciation and amortization	(5,544)		(3,815)
	$	6,915	$	6,328

Depreciation and amortization expense of property and equipment was $1.9 million, $1.6 million, and $1.1 million for the years ended December 31, 2021, 2020, and 2019, respectively.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

The change in the carrying amount of goodwill during the year ended December 31, 2021 included the following (in thousands):


December 31, 2020	$	—
February 25, 2021 Acquisition	109,786
Foreign currency translation adjustment	(4,276)
December 31, 2021	$	105,510

Intangible assets as of December 31, 2021 included the following (in thousands):


		December 31, 2021
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization		Foreign currency translation adjustment		Intangible Assets, Net
Patent license asset	8.71 years	$	1,000	(919)		—		$	81
Exclusive license asset	4 years	3,300		(660)		—		2,640
Technology	12 years	81,100		(5,668)		(1,424)		74,008
Trade names and trademarks	Indefinite	19,700		—		(365)		19,335
Customer relationships	12 years	11,400		(799)		(196)		10,405
		$	116,500	$	(8,046)	$	(1,985)	$	106,469

Intangible asset as of December 31, 2020 included the following (in thousands):


		December 31, 2020
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization	Foreign currency translation adjustment	Intangible Asset, Net
Patent license asset	8.71 years	$	1,000	(804)	—	$	196

The Company recorded expense for the amortization of intangible assets of $7.2 million, $0.1 million, and $0.1 million, respectively, during the years ended December 31, 2021, 2020, and 2019. The estimated future amortization expense as of December 31, 2021, is as follows (in thousands):


2022	$	9,326
2023	9,138
2024	9,011
2025	7,970
2026	7,820

Commitments and Contingencies

12 Months Ended

Dec. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

Operating Leases

In August 2014, the Company entered into a five-year operating lease for approximately 12,215 square feet of office space beginning on November 1, 2014, and expiring on October 31, 2019. In June 2019, the lease was amended to extend the expiration date to October 31, 2020, in September 2020, the lease was amended to extend the expiration date to July 31, 2022, and in December 2021, the lease was amended to extend the expiration date to January 31, 2028. Upon the execution of the amendments, which were deemed to be a lease modification, the Company reassessed the lease liability using the discount rate at the modification date and recorded ROU assets for

the same amount. The Company also reassessed the lease classification and concluded that the lease continues to be an operating lease. Under the terms of the lease, the Company is responsible for taxes, insurance, and maintenance expense. The lease contains certain scheduled rent increases. Rent expense is recognized on a straight-line basis over the expected lease term.

In November 2017, the Company entered into a seven-year operating lease for approximately 25,548 square feet of office space beginning on August 1, 2018, and expiring on August 31, 2025. In June 2019, the lease was amended to extend the expiration date to October 31, 2027. Upon the execution of the amendments, which were deemed to be a lease modification, the Company reassessed the lease liability using the discount rate at the modification date and recorded ROU assets for the same amount. The Company also reassessed the lease classification and concluded that the lease continues to be an operating lease. Under the terms of the lease, the Company is responsible for taxes, insurance, and maintenance expense. The lease contains certain scheduled rent increases. Rent expense is recognized on a straight-line basis over the expected lease term. The Company has a renewal option to extend the term of the lease for a period of five years beyond the initial term. Under the terms of the lease, the base rent payable with respect to each renewal term will be equal to the prevailing market rental rent as of the commencement of the applicable renewal term. In the event of a default of certain of the Company’s obligations under the lease, the Company’s landlord would have the right to terminate the lease.

In June 2019, the Company entered into an eight-year operating lease for approximately 32,621 square feet of office space beginning on January 15, 2020 and expiring on January 31, 2028. The Company uses these premises as its new principal executive offices and for general office space. The Company intends to utilize its other currently-leased spaces through the lease expiration dates to conduct the training of its sales team and for manufacturing purposes. Under the terms of the lease, the Company is responsible for taxes, insurance, and maintenance expense. The lease contains certain scheduled rent increases. Rent expense is recognized on a straight-line basis over the expected lease term. The Company has a renewal option to extend the term of the lease for a period of five years beyond the initial term. Under the terms of the lease, the base rent payable with respect to each renewal term will be equal to the prevailing market rental rent as of the commencement of the applicable renewal term. In the event of a default of certain of the Company’s obligations under the lease, the Company’s landlord would have the right to terminate the lease.

In August 2020, the Company entered into a 38-month operating lease for approximately 5,693 square feet of warehouse space beginning on October 15, 2020 and expiring on December 31, 2023. The Company uses these premises for general warehouse space.

During the years ended December 31, 2021, 2020, and 2019, ROU assets obtained in exchange for new operating lease liabilities were $1.0 million, $3.8 million, and $1.5 million, respectively. As of December 31, 2021 and 2020, the ROU asset has a balance of $7.1 million and $7.1 million, respectively. The operating lease ROU asset is included within the Company’s other non-current assets, and lease liabilities are included in current or noncurrent liabilities on the Company’s consolidated balance sheets. During the years ended December 31, 2021, 2020, and 2019, cash paid for amounts included in operating lease liabilities were $2.0 million, $1.5 million, and $0.9 million, respectively. Amortization of the ROU asset was $1.0 million, $0.9 million, and $0.4 million for the years ended December 31, 2021, 2020, and 2019, respectively. As of December 31, 2021 and 2020, the weighted-average remaining lease term for the Company’s operating leases were 5.9 years and 6.6 years, respectively. The weighted-average discount rate used to determine the present value of the Company’s operating leases’ future payments was 7.1% and 6.7%, respectively.

Total lease cost for the years ended December 31, 2021, 2020, and 2019 are as follows (in thousands):


	December 31,
	2021		2020		2019
Lease cost
Operating lease cost	$	2,107	$	1,991	$	1,031
Short-term lease cost	95		95		177
Variable lease cost	191		179		138
Total lease cost	$	2,393	$	2,265	$	1,346

Payments of operating lease liabilities as of December 31, 2021, are as follows (in thousands):


2022	$	2,063
2023	2,094
2024	2,066
2025	2,150
2026	2,239
Thereafter	2,280
	12,892
Less: imputed interest	(2,474)
	10,418
Less: operating lease liability, current portion	(1,366)
Operating lease liability, net of current portion	$	9,052

License Agreement

In October 2013, the Company entered into the License Agreement, pursuant to which AMF, a Company stockholder, licensed the Company certain patents and know-how (collectively, the AMF IP) relating to, in relevant part, an implantable pulse generator and related system components in development by AMF as of that date, in addition to any peripheral or auxiliary devices, including all components, that when assembled, comprise such device, excluding certain implantable pulse generators (collectively, the AMF Licensed Products). Under the License Agreement, for each calendar year beginning in 2018, the Company is obligated to pay AMF a royalty on an AMF Licensed Product-by-AMF Licensed Product basis if one of the following conditions applies: (i) one or more valid claims within any of the patents licensed to the Company by AMF covers such AMF Licensed Products or the manufacture of such AMF Licensed Products or (ii) for a period of 12 years from the first commercial sale anywhere in the world of such AMF Licensed Product, in each case. The foregoing royalty is calculated as the greater of (a) 4% of all net revenue derived from the AMF Licensed Products, and (b) the Minimum Royalty, payable quarterly. The Minimum Royalty automatically increases each year after 2018, subject to a maximum amount of $200,000 per year. The Company generated net SNM revenue of $157.6 million, $111.5 million, and $13.8 million during the years ended December 31, 2021, 2020, and 2019, respectively, and recorded related royalties of $6.3 million, $4.4 million, and $0.6 million during the years ended December 31, 2021, 2020, and 2019, respectively. Royalty expense is included in operating expenses in the consolidated statements of comprehensive loss. Accrued royalty of $1.8 million and $1.4 million as of December 31, 2021 and 2020, respectively, is included within accrued liabilities on the Company’s consolidated balance sheets.

Legal Matters

On November 4, 2019, Medtronic, Inc., Medtronic Puerto Rico Operations Co., Medtronic Logistics LLC and Medtronic USA, Inc. (collectively, the Medtronic Affiliates) filed a complaint against the Company in the United States District Court for the Central District of California, Case No. 8:19-cv-2115, and amended the complaint on November 26, 2019. The Company refers to this matter as the Medtronic Litigation. The complaint

asserts that the Company’s r-SNM System infringes U.S. Patent Nos. 8,036,756, 8,626,314, 9,463,324 and 9,821,112 held by the Medtronic Affiliates, and the amended complaint further includes the additional patents 8,738,148; 8,457,758; and 7,774,069 (collectively, the Medtronic Patents). The Medtronic Litigation requests customary remedies for patent infringement, including (i) a judgment that the Company has infringed and is infringing the Medtronic Patents, (ii) damages, including treble damages for willful infringement, (iii) a permanent injunction preventing the Company from infringing the Medtronic Patents, (iv) attorneys’ fees, and (v) costs and expenses. The Company believes the allegations are without merit and is vigorously defending itself against them. Given the early stage of the Medtronic Litigation, the Company is unable to predict the likelihood of success of the claims of the Medtronic Affiliates against the Company or to quantify any risk of loss. The Medtronic Litigation could last for an extended period of time and require the Company to dedicate significant financial resources and management resources to its defense. An adverse ruling against the Company could materially and adversely affect its business, financial position, results of operations or cash flows and could also result in reputational harm. Even if the Company is successful in defending against these claims, the Medtronic Litigation could result in significant costs, delays in future product developments, reputational harm or other collateral consequences.

On March 16, 2020, the Company filed seven petitions before the United States Patent and Trademark Office (USPTO) requesting inter partes review (IPR) to contest the validity of each of the Medtronic patents that Medtronic has alleged are being infringed by the Company. In September 2020, the USPTO decided that it will accept or “institute” the IPR process for six of the seven patents, finding that the Company had demonstrated a reasonable likelihood that at least one, if not all, of the claims of these six patents are invalid. The USPTO issued decisions on the IPR petitions in September 2021. The USPTO invalidated several claims in the Medtronic patents but declined to invalidate the majority of asserted claims. The Company appealed the decisions on the claims that were not invalidated. Following these IPR decisions, the judge presiding over the litigation in the United States District Court for the Central District of California lifted the stay on litigation proceedings. The Company is currently engaged in discovery in the Medtronic Litigation.

In addition to the Medtronic Litigation, the Company is and may continue to be involved in claims, legal proceedings, and investigations arising out of its operations in the normal course of business.

Long-Term Debt	12 Months Ended
Long-Term Debt	Dec. 31, 2021
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt In February 2018, the Company entered into the Loan and Security Agreement (the Loan Agreement), with Silicon Valley Bank, providing for a term loan (the Term Loan). In January 2021, the principal amount, accrued interest, accrued loan fees, and prepayment fees related to the Term Loan were paid in full. The unamortized debt issuance costs of $0.4 million was expensed and recognized as interest expense. In February 2021, the Company entered into another Loan and Security Agreement with Silicon Valley Bank, under which the Company obtained a loan in the principal amount of $75 million. The Loan under the Loan and Security Agreement matures on February 1, 2024, unless earlier accelerated upon an event of default. The Loan bears interest at a floating per annum rate equal to the greater of (a) 9.00% and (b) 5.75% above the current prime rate, with only interest due and payable monthly until September 1, 2022, at which time interest and principal will be due and payable monthly in equal monthly payments. The Loan and Security Agreement also sets out that the Loan is subject to a final payment fee equal to 6.00% of the aggregate principal amount of the Loan. The loan allowed for prepayments of amounts outstanding under the Loan and Security Agreement at any time with 5 days prior written notice to Silicon Valley Bank. In the event that the Company elects to prepay the Loan prior to the Maturity Date, the Company is required to pay a fee in the amount of (a) 2.00% of the outstanding principal balance if such prepayment occurs prior to February 25, 2022 or (b) 1.00% of the outstanding principal balance if such prepayment occurs on or after February 25, 2022. The Loan and Security Agreement contains customary events of default that include, among others, non-payment defaults, covenant defaults, a default in the event a material adverse change occurs, defaults in the event our assets are attached or the Company is enjoined from doing business, bankruptcy and insolvency defaults, cross-defaults to certain other material indebtedness, material judgment defaults, and inaccuracy of representations and warranties. The occurrence of an event of default could result in an increase to the applicable interest rate of 5.00%, acceleration of and present occurrence of the Maturity Date, and the consequent obligation for the Company to repay in full in cash all amounts outstanding under the Loan and Security Agreement, and a right by the lenders to exercise all remedies available under the Loan and Security Agreement and related agreements, including the right to dispose of the collateral as permitted under applicable law. All obligations under the Term Loan are secured by a first priority lien on substantially all of the Company’s assets, excluding intellectual property assets and more than 65% of the shares of voting capital stock of any of its foreign subsidiaries. The Company has agreed with Silicon Valley Bank not to encumber its intellectual property assets without Silicon Valley Bank’s prior written consent unless a security interest in the underlying intellectual property is necessary to have a security interest in the accounts and proceeds that are part of the assets securing the Term Loan, in which case the Company’s intellectual property shall automatically be included within the assets securing the Term Loan. The Loan Agreement contains certain covenants that limit our ability to engage in certain transactions that may be in our long-term best interest. Subject to certain limited exceptions, these covenants limit our ability to or prohibit us to permit any of our subsidiaries to, as applicable, among other things: •pay cash dividends on, make any other distributions in respect of, or redeem, retire or repurchase, any shares of our capital stock; •convey, sell, lease, transfer, assign, or otherwise dispose of all or any part of our business or property; •effect certain changes in our business, management, ownership or business locations; •merge or consolidate with, or acquire all or substantially all of the capital stock or property of any other company; •create, incur, assume, or be liable for any additional indebtedness, or create, incur, allow, or permit to exist any additional liens; •make certain investments; and •enter into transactions with our affiliates. In June 2021, the principal amount, accrued interest, accrued loan fees, and prepayment fees related to the term loan under the Loan and Security Agreement with Silicon Valley Bank entered into in February 2021, were paid in full. The unamortized debt issuance costs of $4.4 million was expensed and recognized as interest expense.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-URI http://asc.fasb.org/topic&trid=2208564

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (h)
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+ Details

Stockholders' Equity

12 Months Ended

Dec. 31, 2021

Equity [Abstract]

Stockholders' Equity

Stockholders’ Equity

Preferred Stock

As of December 31, 2021, the Company is authorized to issue 10,000,000 shares of preferred stock with a par value of $0.0001 per share.

Common Stock

The following summarizes the rights of holders of our common stock:

Voting

The holders of our common stock are entitled to one vote per share. The number of authorized shares of common stock may be increased or decreased (but not below the number of shares thereof then outstanding) by the affirmative vote of the holders of a majority of the voting power of our capital stock entitled to vote, irrespective of the provisions of Section 242(b)(2) of the DGCL.

Dividends

Subject to preferences that may be applicable to the holders of outstanding shares of preferred stock and subject to applicable law, dividends may be declared and paid on the holders of our common stock when and as determined by our board of directors out of assets legally available for dividends.

As a Delaware corporation, the Company will be subject to certain restrictions on dividends under the DGCL. Generally, a Delaware corporation may only pay dividends either out of “surplus” or out of the current or the immediately preceding year’s net profits. Surplus is defined as the excess, if any, at any given time, of the total assets of a corporation over its total liabilities and statutory capital. The value of a corporation’s assets can be measured in a number of ways and may not necessarily equal their book value.

Liquidation Rights

Upon our voluntary or involuntary liquidation, dissolution or winding up, after satisfaction of all our liabilities and the payment of any liquidation preference of any outstanding preferred stock, the holders of shares of common stock will be entitled to share in all of our assets legally remaining for distribution after payment of all debt and other liabilities, subject to preferences that may be applicable to the holders of outstanding shares of preferred stock.

Redemption Rights

There are no redemption or sinking fund provisions applicable to our common stock.

Preemptive Rights and Conversion Rights

There are no preemptive or conversion rights applicable to our common stock.

Stock-Based Compensation Expense

Stock-based compensation expense included in the Company’s consolidated statements of comprehensive loss is allocated as follows (in thousands):


	Years Ended December 31,
	2021		2020		2019
Research and development	$	5,980	$	3,457	$	1,725
General and administrative	8,079		5,852		3,950
Sales and marketing	11,105		5,786		3,045
	$	25,164	$	15,095	$	8,720

Stock Option Activity

2014 Stock Option Plan

In 2014, the Company established its 2014 Stock Option Plan (the 2014 Plan), which provides for the granting of stock options to employees, directors, and consultants of the Company. As of December 31, 2021 and 2020, a total of 3,130,064 and 3,131,624 common shares have been reserved for issuance under the 2014 Plan, respectively. As of December 31, 2021 and 2020, there were no stock options available for grant under the 2014 Plan. The 2018 Omnibus Incentive Plan was adopted upon our IPO and replaced the 2014 Stock Option Plan for future grants.

2018 Omnibus Incentive Plan

On October 18, 2018, the Company adopted the 2018 Omnibus Incentive Plan (the 2018 Plan), under which the Company may grant cash and equity incentive awards to eligible service providers to attract, motivate and retain the talent for which it competes. The 2018 Plan provides for awards based on shares of the Company’s common stock. Subject to adjustment by the Company’s board of directors, the total number of shares authorized to be awarded under the 2018 Plan may not exceed 4,588,548. As of December 31, 2021 and 2020, there were 950,354 and 1,678,326 shares available for grant under the 2018 Plan, respectively.

The Company had shares of common stock reserved for future issuance as follows at:


	December 31,
	2021	2020

Options outstanding under the 2014 Plan	277,505	501,598

Options and restricted stock-based awards outstanding under the 2018 Plan	2,502,885	2,477,929
Options and restricted stock-based awards remaining under the 2018 Plan for future issuance	950,354	1,678,326
	3,730,744	4,657,853

The fair value of each stock option is measured as of the date of grant, and compensation expense is recognized over the period during which the recipient renders the required services to the Company (typically the vesting period). Stock-based compensation expense recognized is based on the estimated number of stock options that are expected to ultimately become exercisable. Forfeitures are estimated at the time of the grant and revised in subsequent periods to reflect differences between the estimates and the number of shares that become exercisable.

The option awards issued under the 2014 and 2018 Plans were measured based on fair value. The Company’s fair value calculations were made using the Black-Scholes option pricing model with the following assumptions:


	Years Ended December 31,
	2021	2020	2019
Expected term (in years)	5.46 - 6.00	6.05	5.07 - 6.16
Stock volatility	63.49%	72.01%	70.02% - 77.52%
Risk-free interest rate	0.53% - 1.16%	1.37%	1.42% - 2.56%
Dividend rate	—	—	—

The Company used the simplified method of determining the expected term of stock options as the Company believes this represents the best estimate of the expected term of a new option. The expected stock price volatility assumption was determined by examining the historical volatilities for industry peers, as the Company did not have sufficient trading history for the Company’s common stock. The Company will continue to analyze the historical stock price volatility and expected term assumption as more historical data for the Company’s common stock becomes available. The risk-free interest rate assumption is based on the U.S. Treasury instruments, whose term was consistent with the expected term of the Company’s stock options. The expected dividend assumption is based on the Company’s history and expectation of dividend payouts. The assumptions regarding the expected term of the options and the expected volatility of the stock price are subjective, and these assumptions have a significant effect on the estimated fair value amounts. The weighted-average grant date fair value of options granted was $32.93, $18.56, and $13.79 for the years ended December 31, 2021, 2020, and 2019 respectively.

As of December 31, 2021 and 2020, there was $6.7 million and $11.6 million, respectively, of total unrecognized compensation cost related to unvested stock options that is expected to be recognized over a weighted-average period of approximately 1.6 years and 2.4 years, respectively.

The following table summarizes stock option activity under the 2014 and 2018 Plans (in thousands, except share and per share data):


	Number of Options	Weighted-Average Exercise Price Per Share		Aggregate Intrinsic Value



Outstanding at December 31, 2018	1,514,347	$	2.22
Options granted	1,671,044	21.28
Options exercised	(281,744)	1.79		$	7,386	(1)
Options forfeited	(56,546)	13.43
Outstanding at December 31, 2019	2,847,101	13.22
Options granted	5,000	29.03
Options exercised	(767,792)	5.05		$	25,066	(1)
Options forfeited	(129,066)	20.20
Outstanding at December 31, 2020	1,955,243	16.01
Options granted	46,000	58.07
Options exercised	(522,495)	12.60		$	24,455	(1)
Options forfeited	(50,856)	29.64
Outstanding at December 31, 2021	1,427,892	$	18.13	$	54,190	(2)
Options exercisable at December 31, 2021	917,909	$	15.62	$	37,064	(2)

_____________________________________________

(1) Represents the total difference between the Company’s closing stock price at the time of exercise and the stock option exercise price, multiplied by the number of options exercised.

(2) Represents the total difference between the Company’s closing stock price on the last trading day of 2021 and the stock option exercise price, multiplied by the number of in-the-money options as of December 31, 2021. The amount of intrinsic value will change based on the fair market value of the Company’s stock.

The weighted-average remaining contractual term of options outstanding and exercisable is 6.9 years and 7.7 years at December 31, 2021 and 2020, respectively.

Restricted Shares Awards Activity

As of December 31, 2021 and 2020, there was $42.5 million and $22.6 million, respectively, of total unrecognized compensation cost related to unvested restricted shares awards that is expected to be recognized over a weighted-average period of approximately 3.0 years and 3.3 years, respectively.

The following table summarizes restricted shares awards activity:


	Number of Restricted Shares Awards	Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2018	50,000	$	14.48
Restricted shares awards granted	580,667	24.08
Restricted shares awards vested	(27,551)	18.80
Restricted shares awards forfeited	(16,950)	21.09
Outstanding at December 31, 2019	586,166	23.59
Restricted shares awards granted	502,500	37.68
Restricted shares awards vested	(174,890)	23.29
Restricted shares awards forfeited	(96,593)	28.83
Outstanding at December 31, 2020	817,183	31.70
Restricted shares awards granted	638,936	57.90
Restricted shares awards vested	(235,560)	31.19
Restricted shares awards forfeited	(118,525)	40.33
Outstanding at December 31, 2021	1,102,034	$	46.07

Restricted Stock Units Activity

As of December 31, 2021 and 2020, there was $1.9 million and $1.2 million, respectively, of total unrecognized compensation cost related to unvested restricted stock units that is expected to be recognized over a weighted-average period of approximately 0.9 years and 0.9 years, respectively.

The following table summarizes restricted stock units activity:


	Number of Restricted Stock Units	Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2018	—	$	—
Restricted stock units granted	248,104	21.48
Outstanding at December 31, 2019	248,104	21.48
Restricted stock units granted	8,000	29.03
Restricted stock units vested	(46,336)	14.19
Restricted stock units forfeited	(2,667)	14.19
Outstanding at December 31, 2020	207,101	23.49
Restricted stock units granted	212,417	43.62
Restricted stock units vested	(169,054)	19.89

Outstanding at December 31, 2021	250,464	$	42.99

Stock Warrants

On July 16, 2019, the Company issued and sold 32,529 shares of its common stock to SVB Financial Group (SVB) in connection with the exercise by SVB of its right to purchase 40,000 shares of its common stock under that certain warrant, dated as of February 6, 2018. The exercise price per share was $7.50 and was paid by SVB via forfeiture of shares pursuant to a cashless exercise provision in the warrant.

On May 29, 2019, the Company issued and sold 31,071 shares of its common stock to Life Science Loans II, LLC (Life Science Loans) in connection with the exercise by Life Science Loans of its right to purchase 40,000 shares of its common stock under that certain warrant, dated as of February 6, 2018. The exercise price per share was $7.50 and was paid by Life Science Loans via forfeiture of shares pursuant to a cashless exercise provision in the warrant.

No warrants were outstanding at December 31, 2021 and 2020.

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

The components of net loss (income) before income tax expense were as follows (in thousands):


	Years Ended December 31,
	2021		2020		2019
Domestic	$	(56,105)	$	(54,994)	$	(80,322)
Foreign	(23,180)		80		388
Total	$	(79,285)	$	(54,914)	$	(79,934)

The components of the income tax expense (benefit) were as follows (in thousands):


	Years Ended December 31,
	2021		2020		2019
Current:
Federal	$	—	$	—	$	—
State	211		1		1
Foreign	26		—		—
Total current income tax expense	$	237	$	1	$	1
Deferred:
Federal	$	(422)	$	—	$	—
State	(117)		—		—
Foreign	1,084		—		—
Total deferred income tax expense	$	545	$	—	$	—
Total	$	782	$	1	$	1

The reconciliation between the Company’s effective tax rate and the statutory tax rate is as follows:


	Years Ended December 31,
	2021		2020		2019
Tax at statutory federal rate	21.0	%	21.0	%	21.0	%
State tax, net of federal benefit	3.8	%	7.0	%	7.0	%
Excess tax benefits related to stock-based compensation	9.4	%	10.3	%	(1.0)	%
Non-deductible stock-based compensation	(1.4)	%	—	%	—	%
Tax rate change	(5.2)	%	—	%	—	%
Net operating loss adjustments	(7.9)	%	—	%	—	%
Section 382 limitation	—	%	—	%	(5.0)	%
R&D tax credit, net of reserve	6.1	%	(4.5)	%	—	%
Change in valuation allowance	(24.5)	%	(36.8)	%	(21.5)	%
Other	(2.3)	%	3.0	%	(0.5)	%
Effective tax rate	(1.0)	%	—	%	—	%

Our effective tax rate was 1.0% for the year ended December 31, 2021, compared to an effective tax rate of 0.0% for the year ended December 31, 2020 and 0.0% for the year ended December 31, 2019. The effective tax rates for the periods presented are primarily comprised of U.S. and foreign statutory taxes, excess tax benefits related to stock-based compensation, change in foreign statutory income tax rates, and a change in valuation allowance. The difference in the effective tax rate of 1.0% for the year ended December 31, 2021 as compared to the effective tax rate of 0.0% for the year ended December 31, 2020 was due to statutory tax rate increases in the U.K. offset by losses in certain foreign jurisdictions, of which are being benefited.

Deferred income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of the Company’s deferred tax assets and liabilities are as follows (in thousands) as of:


	December 31,
	2021		2020
Deferred Tax Assets:
Share-based compensation	$	5,367	$	592
Depreciation and amortization	7		145
Lease liability	895		901
Net operating loss carryforwards	74,744		59,176
Research and development credit carryforwards	4,865		—
Interest expense limitation carryforwards	2,518		—
Other	2,895		4,438
Total deferred tax assets	91,291		65,252
Less: valuation allowance	(85,061)		(65,252)
Total net deferred tax assets	$	6,230	$	—

Deferred Tax Liabilities:
Intangibles	$	(25,447)	$	—
Total deferred tax liabilities	$	(25,447)	$	—

Net deferred tax liabilities	$	(19,217)	$	—

At December 31, 2021, the Company had U.S. federal and foreign net operating loss (NOL) carryforwards of approximately $258.2 million and $16.4 million, respectively. Of the U.S. federal NOLs, $51.5 million will expire between 2033 and 2037 and the remainder will carryover indefinitely. The Company had U.S. state NOLs of $245.6 million, which will expire between 2033 and 2041. Under California Assembly Bill 85, effective June 29, 2020, net operating loss deductions were suspended for tax years beginning in 2020, 2021, and 2022 and the carry forward periods of any net operating losses not utilized due to such suspension were extended. The foreign net operating loss carryforwards have an indefinite carryforward period.

The Company accounts for income taxes according to ASC 740. The Company periodically evaluates whether a portion or all of its deferred tax assets will be recovered. The Company records a valuation allowance against deferred tax assets if and to the extent it is more likely than not that they will not be recovered. In evaluating the need for a valuation allowance, the Company weighs all relevant positive and negative evidence, including among other factors, historical financial performance, forecasts of income over the applicable carryforward periods, and the market environment, with each consideration weighted based on its reliability. The Company continues to maintain a full valuation allowance against its otherwise recognizable U.S. deferred income tax assets as of December 31, 2021 and 2020. The Company has determined, after evaluating all positive and negative historical and prospective evidence, that it is more likely than not that the deferred income tax assets will not be realized. The valuation allowance increased by $19.8 million for the year ended December 31, 2021, from $65.3 million to $85.1 million. This increase in the valuation allowance during the year ended December 31, 2021, was largely

attributable to losses incurred in the U.S. jurisdiction. The Company’s NOL carryforwards were generated from domestic and foreign operations.

Pursuant to Sections 382 and 383 of the Internal Revenue Code of 1986, as amended (the Internal Revenue Code), use of the Company’s NOL carryforwards may be limited if the Company experiences a cumulative change in ownership of greater than 50% in a rolling three-year period. The Company performed an analysis of changes in ownership for purposes of these Internal Revenue Code sections. Based on the study performed in 2020, the Company determined that an ownership change occurred in 2014, 2018 and 2019. The total reduction to the net operating loss carryforwards and R&D credit was $12.2 million and $1.5 million, respectively. Based on the study performed in 2021, the Company determined that an ownership change did not occur in 2021. The total reduction of the net operating loss carryforwards was offset by valuation allowance, and there was no impact to tax expense related to the limitation. Future ownership changes could impact the Company’s ability to utilize NOL carryforwards.

The Company applies the provisions of FASB ASC 740-10, “Accounting for Uncertainty in Income Taxes.” ASC 740-10 prescribes a comprehensive model for the recognition, measurement, presentation and disclosure in financial statements of any uncertain tax positions that have been taken or are expected to be taken on a tax return. The Company has identified unrecognized tax benefits or uncertain tax positions. There has been a liability on uncertain tax positions recorded on the financial statements as of December 31, 2021. The Company does not expect that its assessment regarding unrecognized tax benefits and uncertain tax positions will materially change over the following 12 months.

A reconciliation of the beginning and ending balances of unrecognized tax benefits is as follows (in thousands):


Balance at December 31, 2019	$	—
Deductions based on tax positions related to prior years	—
Additions based on tax positions related to the current year	2,491
Balance at December 31, 2020	2,491
Additions based on tax positions related to the current year	528

Additions from business combination	1,782
Deductions for tax positions taken in prior years	(1,397)
Balance at December 31, 2021	$	3,404

As of December 31, 2021, the total unrecognized tax benefits was $3.4 million, of which, if recognized, $0.1 million would affect the annual effective tax rate. Additionally, approximately $1.7 million of the unrecognized tax position is subject to an indemnification, and as such these amounts will not result in economic exposure for the Company. The Company does not believe that the amount of unrecognized tax benefits will change significantly in the next 12 months. As of December 31, 2021, the Company has accumulated $0.4 million in both interest and penalties associated with uncertain tax positions. There were no interest or penalties to be recognized for the tax years ended December 31, 2020, and 2019.

The Company has net operating loss and research and development credit carryforwards which may be subject to examination by taxing authorities. As of December 31, 2021, tax years beginning with the year ended December 31, 2017 remain subject to examination by the Internal Revenue Service and certain U.S. state jurisdictions. As of December 31, 2021, tax years beginning with the years ended December 31, 2015, December 31, 2017, and December 31, 2017 remain subject to examination by the German, French, and the U.K. tax authorities, respectively. The Company is not currently under audit by any taxing authority.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

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+ Details

Employee Benefit Plan	12 Months Ended
Employee Benefit Plan	Dec. 31, 2021
Retirement Benefits [Abstract]
Employee Benefit Plan	Employee Benefit PlanThe Company sponsors a defined contribution retirement savings plan under Section 401(k) of the Internal Revenue Code. This plan covers all employees who meet minimum age and service requirements and allows participants to defer a portion of their annual compensation on a pre- or post-tax basis. Contributions to the plan by the Company may be made at the discretion of the board of directors. During the years ended December 31, 2021, 2020, and 2019, the Company contributions to the plan amounted to $1.9 million, $1.6 million, and $1.1 million, respectively.

- Definition

The entire disclosure for retirement benefits.

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+ Details

Acquisition

12 Months Ended

Dec. 31, 2021

Business Combination and Asset Acquisition [Abstract]

Acquisition

On February 25, 2021, the Company acquired all issued and outstanding shares of Contura Limited (Contura) through a Share Purchase Agreement. As a result of the acquisition, the Company acquired a 100% equity interest in Contura.

The Company accounted for the acquisition as a business combination pursuant to ASC 805. In accordance with ASC 805, fair values are assigned to tangible and identifiable intangible assets acquired and liabilities assumed at the acquisition date based on the information that was available as of the acquisition date. The Company believes that the information available provides a reasonable basis for estimating the fair values of assets acquired and liabilities assumed for the acquisition.

The purchase price consideration for the acquisition totaled $204.7 million, of which $141.4 million was in the form of cash and $55.7 million was in the form of 1,096,583 shares of the Company’s common stock. Additionally, a payment of $35 million may be paid to Contura if the Company is able to generate $50 million in Bulkamid sales within a 12-month period before December 31, 2024. As the additional payment is contingent on future sales, an estimate of fair value was assessed to be $7.6 million which is considered part of the purchase price consideration and was recorded as other long-term liabilities in the consolidated balance sheet. The cash consideration paid for the acquisition was funded by existing cash on hand.

The following table presents the purchase price allocation of Contura assets acquired and liabilities assumed, based on their estimated fair values as of the February 25, 2021 acquisition date (in thousands):


	Purchase Price Allocation
Assets Acquired
Cash and cash equivalents	$	593
Accounts receivable	1,688
Inventory	988
Prepaid expenses and other current assets	115
Property and equipment	52
Other assets	108
Intangible assets	112,200
Total assets acquired	115,744
Liabilities Assumed
Accounts payable	209
Accrued liabilities	820
Accrued compensation and benefits	315
Lease liability	86
Debt	122
Deferred tax liabilities	19,286
Total liabilities assumed	20,838

Net assets acquired	94,906
Purchase price consideration	204,692
Goodwill	$	109,786

Intangible assets

Identified intangible assets consist of technology, trade names and trademarks, and customer relationships. The fair value of intangible assets and the determination of their respective useful lives were made in accordance with ASC 805 and are outlined in the table below:


	Fair Value (in thousands)		Useful Life
Technology	$	81,100	12 years
Trade names and trademarks	$	19,700	Indefinite
Customer relationships	$	11,400	12 years

Intangible assets were valued using models and approaches best suited for the asset type.

Technology was valued using the Multi-Period Excess Earnings Method (MPEEM), which calculates economic benefits by determining the income attributable to an intangible asset after returns are subtracted for contributory assets. Assumptions in the MPEEM include projected revenue growth rates, future margins, royalty rate indication, and tax rate.

Trade names and trademarks were valued using the Relief from Royalty Method. The relief from royalty method is a variant of the discounted cash flow method, which is a form of the income approach. It is based on the premise that ownership of the intangible asset relieves the need to pay a licensing fee for the ability to use the asset. Assumptions include a discount rate, tax rate, royalty rate indication, long-term growth rate, and implied profit split time period.

Customer relationships were valued using the distributor method. The distributor method was utilized as the asset was determined to be a secondary intangible asset and the Company’s product could be sold through distributors. Assumptions used in the distributor method include projected revenue growth rates, future margins, rate of customer retention, and an appropriate discount rate.

Intangible assets will be amortized based on their useful life. $6.5 million in amortization expense relating to these intangible assets was recognized during the year ended December 31, 2021 in the consolidated statements of comprehensive loss. The unamortized balance as of December 31, 2021 was $103.7 million. The total weighted-average original amortization period for the acquired finite-lived intangible assets is 12 years.

Goodwill

Goodwill is calculated as the excess of the consideration transferred over the fair value of the identifiable net assets acquired in a business combination and represents the future economic benefits expected to arise from anticipated synergies and intangible assets acquired that do not qualify for separate recognition, including an assembled workforce, noncontractual relationships, and other agreements. As an indefinite-lived asset, goodwill is not amortized but rather is subject to impairment testing on at least an annual basis. The Contura acquisition resulted in the recognition of $109.8 million of goodwill, which is not expected to be deductible for tax purposes.

Contingent consideration

As part of the transaction, the Company agreed to pay Contura $35 million if Bulkamid sales achieve $50 million in any 12-month period before December 31, 2024. The preliminary fair value of the estimated contingent consideration was determined by using a binary option-based approach. Inputs used in the assessment include the Company’s projected revenue rate, an appropriate discount rate, volatility, and risk-free rate. The estimated fair value of the contingent consideration was preliminarily determined to be $6.8 million. After the March 31, 2021 interim financial statements were issued, the Company received a final valuation report from a third-party valuation firm relating to the contingent consideration. After considering the results of that valuation report, the Company estimated the fair value of the contingent consideration to be $7.6 million as of the acquisition date. As a result, the fair value of the contingent consideration increased by $0.8 million with a corresponding increase to goodwill.

To the extent that the forecast milestone achievements probabilities changed, future fair value measurement adjustments to the contingent consideration liability will be recognized in the consolidated statements of comprehensive loss.

Deferred tax liabilities

After the March 31, 2021 interim financial statements were issued, the Company received a preliminary tax provision report from a third-party tax firm. After considering the results of that tax provision report, the Company preliminarily estimated the fair value of the deferred tax liabilities assumed to be $17.9 million. As a result, the fair value of the deferred tax liabilities increased by $17.9 million with a corresponding increase to goodwill.

After the June 30, 2021 interim financial statements were issued, the Company received an updated preliminary tax provision report from a third-party tax firm. After considering the results of that tax provision report, the Company estimated the fair value of the deferred tax liabilities assumed to be $23.8 million. As a result, the fair value of the deferred tax liabilities increased by $5.9 million with a corresponding increase to goodwill.

After the September 30, 2021 interim financial statements were issued, the Company received a final tax provision report from a third-party tax firm. After considering the results of that tax provision report, the Company estimated the fair value of the deferred tax liabilities assumed to be $19.3 million. As a result, the fair value of the deferred tax liabilities decreased by $4.5 million with a corresponding decrease to goodwill.

Transaction-related costs

Acquisition costs are not included as components of consideration transferred and instead are accounted for as expenses in the period in which the costs are incurred. The Company incurred $4.4 million of acquisition-related costs in the first quarter of fiscal year 2021.

Pro forma (Unaudited)

The following unaudited pro forma financial information presents the consolidated results of operations of the Company with Contura for the years ended December 31, 2021 and 2020, as if the acquisition had occurred on January 1, 2020 instead of February 25, 2021 (in thousands, except share and per share data). Contura’s revenue and net loss for the year ended December 31, 2021 were $24.1 million and $2.8 million, respectively, of which $22.7 million in revenue and $2.2 million in net income was recognized after the February 25, 2021 acquisition date. Revenue and net income recognized after the acquisition date were recorded within the Company’s consolidated statements of comprehensive loss. The pro forma information does not necessarily reflect the results of operations that would have occurred had the entities been a single company during the respective periods.


	Years Ended December 31,
	2021		2020
Net revenue	$	181,643	$	122,444
Net loss	$	(77,535)	$	(63,183)
Net loss per share, basic and diluted	$	(1.79)	$	(1.66)
Weighted-average shares used to compute basic and diluted net loss per share	43,237,536		38,077,918

The unaudited pro forma financial information above reflects the following pro forma adjustments:

•An adjustment to decrease net loss for the year ended December 31, 2021 by $4.4 million to eliminate integration and acquisition related costs incurred by the Company and Contura and a corresponding increase to net loss for the year ended December 31, 2020 by $4.4 million to give effect to the integration and acquisition of Contura as if it had occurred on January 1, 2020.

•An adjustment to increase net loss for the year ended December 31, 2021 by $1.3 million and a corresponding increase to net loss for the year ended December 31, 2020 by $7.8 million to reflect amortization of the fair value adjustments for intangible assets as if the assets were acquired January 1, 2020.

•An adjustment to decrease net loss for the year ended December 31, 2020 by $2.2 million to reflect remeasurement of the fair value adjustments for deferred tax liabilities as if the liabilities were assumed January 1, 2020.

Nature of Operations and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Principles of Consolidation

Technologies Australia Pty Ltd, Axonics Women’s Health Limited, Bulkamid SARL, Axonics GmbH, and Contura, Inc. Intercompany accounts and transactions have been eliminated in consolidation.

Basis of Presentation

Use of Estimates

Revenue Recognition

Revenue recognized during the years ended December 31, 2021, 2020, and 2019 relates entirely to the sale of the Company’s products to its customers and distributors.

Shipping and Handling Costs

Allowance for Credit Losses

Cash and Cash Equivalents

Fair Value of Financial Instruments

•Level 1: Inputs are unadjusted quoted prices in active markets for identical assets or liabilities.

The following table summarizes the changes in the fair value of recurring Level 3 fair value measurements during the year ended December 31, 2021 (in thousands):




Liabilities
Contingent consideration:
December 31, 2020	$	—
February 25, 2021 Acquisition	7,630
Change in fair value included in earnings	2,740
December 31, 2021	$	10,370

There were no transfers between Levels 1, 2 or 3 for the periods presented.

Investment Securities

Foreign Currency Translation

Inventory, Net

Property and Equipment

Goodwill

GoodwillGoodwill represents the excess purchase price over the fair values of the identifiable assets acquired less the liabilities assumed. Goodwill is tested for impairment at the reporting unit level by comparing the reporting unit’s carrying amount to the fair value of the reporting unit. The fair values are estimated using an income and discounted cash flow approach. The Company evaluates its goodwill on an annual basis in the fourth quarter or more frequently if it believes indicators of impairment exist. The Company assesses qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount or performs an annual impairment test. When tested quantitatively, the Company compares the fair value of the applicable reporting unit with its carrying value. In making this assessment, management relies on a number of factors, including expected future operating results, business plans, economic projections, anticipated future cash flows, business trends and declines in the Company’s market capitalization. The Company estimates the fair values of its reporting unit using a combination of the discounted cash flow (DCF) and income approaches. If the carrying amount of a reporting unit exceeds the reporting unit’s fair value, the amount by which the carrying value exceeds the fair value is recognized as an impairment loss.

Intangible Assets

Patent license asset

Exclusive license asset

Contura acquisition

Impairment of Long-Lived Assets

Impairment of Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability is measured by comparing the carrying amount to the future net cash flows that the assets are expected to generate. If said assets are considered to be impaired, the impairment that would be recognized is measured by the amount by which the carrying amount of the assets exceeds the projected discounted future net cash flows arising from the asset.

Leases

Research and Development

Research and Development Research and development costs are charged to operations as incurred. Research and development costs include salary and personnel-related costs, costs of clinical studies and testing, supplies and materials, and outside consultant costs.

Advertising Expense

Advertising ExpenseThe Company expenses advertising costs as they are incurred.

Income Taxes

Stock-Based Compensation

Net Loss per Share of Common Stock

Segment Reporting

Recently Adopted Accounting Pronouncements and Recent Accounting Pronouncements

Recently Adopted Accounting Pronouncements

Recent Accounting Pronouncements

Nature of Operations and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Revenue Disaggregated by Geographic Market

The following table provides additional information pertaining to net revenue disaggregated by product and geographic market for the years ended December 31, 2021, 2020, and 2019 (in thousands):


	Years Ended December 31,
	2021		2020		2019
SNM net revenue
United States	$	153,837	$	107,542	$	8,376
International markets	3,753		3,993		5,444
	$	157,590	$	111,535	$	13,820
Bulkamid net revenue
United States	$	12,660	$	—	$	—
International markets	10,040		—		—
	$	22,700	$	—	$	—
Total net revenue	$	180,290	$	111,535	$	13,820

Schedule of Changes in Allowance for Credit Losses

The following table summarizes the changes in our allowance for credit losses (in thousands):


	Years Ended December 31,
	2021		2020		2019
Balance at beginning of period	$	465	$	75	$	—
Write-offs	12		—		—
Bad debt (recoveries) expense	(122)		390		75
Balance at end of period	$	355	$	465	$	75

Schedule of Changes in Fair Value of Liabilities Measured on Recurring Basis

The following table summarizes the changes in the fair value of recurring Level 3 fair value measurements during the year ended December 31, 2021 (in thousands):




Liabilities
Contingent consideration:
December 31, 2020	$	—
February 25, 2021 Acquisition	7,630
Change in fair value included in earnings	2,740
December 31, 2021	$	10,370

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

Property and equipment, net consists of the following (in thousands) at:


	December 31,
	2021		2020
Equipment	$	2,429	$	1,205
Computer hardware and software	2,450		2,286
Tools and molds	1,579		1,404
Leasehold improvements	4,372		3,759
Furniture and fixtures	1,502		1,360
Construction in progress	127		129
	12,459		10,143
Less: accumulated depreciation and amortization	(5,544)		(3,815)
	$	6,915	$	6,328

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Carrying Amount of Goodwill

The change in the carrying amount of goodwill during the year ended December 31, 2021 included the following (in thousands):


December 31, 2020	$	—
February 25, 2021 Acquisition	109,786
Foreign currency translation adjustment	(4,276)
December 31, 2021	$	105,510

Schedule of Finite-Lived and Indefinite-Lived Intangible Assets

Intangible assets as of December 31, 2021 included the following (in thousands):


		December 31, 2021
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization		Foreign currency translation adjustment		Intangible Assets, Net
Patent license asset	8.71 years	$	1,000	(919)		—		$	81
Exclusive license asset	4 years	3,300		(660)		—		2,640
Technology	12 years	81,100		(5,668)		(1,424)		74,008
Trade names and trademarks	Indefinite	19,700		—		(365)		19,335
Customer relationships	12 years	11,400		(799)		(196)		10,405
		$	116,500	$	(8,046)	$	(1,985)	$	106,469

Intangible asset as of December 31, 2020 included the following (in thousands):


		December 31, 2020
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization	Foreign currency translation adjustment	Intangible Asset, Net
Patent license asset	8.71 years	$	1,000	(804)	—	$	196

Schedule of Estimated Future Amortization Expense

The estimated future amortization expense as of December 31, 2021, is as follows (in thousands):


2022	$	9,326
2023	9,138
2024	9,011
2025	7,970
2026	7,820

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Schedule of Total Lease Cost

Total lease cost for the years ended December 31, 2021, 2020, and 2019 are as follows (in thousands):


	December 31,
	2021		2020		2019
Lease cost
Operating lease cost	$	2,107	$	1,991	$	1,031
Short-term lease cost	95		95		177
Variable lease cost	191		179		138
Total lease cost	$	2,393	$	2,265	$	1,346

Schedule of Payments of Operating Lease Liabilities

Payments of operating lease liabilities as of December 31, 2021, are as follows (in thousands):


2022	$	2,063
2023	2,094
2024	2,066
2025	2,150
2026	2,239
Thereafter	2,280
	12,892
Less: imputed interest	(2,474)
	10,418
Less: operating lease liability, current portion	(1,366)
Operating lease liability, net of current portion	$	9,052

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2021

Equity [Abstract]

Schedule of Stock-based Compensation Expense

Stock-based compensation expense included in the Company’s consolidated statements of comprehensive loss is allocated as follows (in thousands):


	Years Ended December 31,
	2021		2020		2019
Research and development	$	5,980	$	3,457	$	1,725
General and administrative	8,079		5,852		3,950
Sales and marketing	11,105		5,786		3,045
	$	25,164	$	15,095	$	8,720

Schedule of Common Stock Reserved for Future Issuance

The Company had shares of common stock reserved for future issuance as follows at:


	December 31,
	2021	2020

Options outstanding under the 2014 Plan	277,505	501,598

Options and restricted stock-based awards outstanding under the 2018 Plan	2,502,885	2,477,929
Options and restricted stock-based awards remaining under the 2018 Plan for future issuance	950,354	1,678,326
	3,730,744	4,657,853

Schedule of Stock Option Award Valuation Assumptions


	Years Ended December 31,
	2021	2020	2019
Expected term (in years)	5.46 - 6.00	6.05	5.07 - 6.16
Stock volatility	63.49%	72.01%	70.02% - 77.52%
Risk-free interest rate	0.53% - 1.16%	1.37%	1.42% - 2.56%
Dividend rate	—	—	—

Schedule of Stock Option Activity

The following table summarizes stock option activity under the 2014 and 2018 Plans (in thousands, except share and per share data):


	Number of Options	Weighted-Average Exercise Price Per Share		Aggregate Intrinsic Value



Outstanding at December 31, 2018	1,514,347	$	2.22
Options granted	1,671,044	21.28
Options exercised	(281,744)	1.79		$	7,386	(1)
Options forfeited	(56,546)	13.43
Outstanding at December 31, 2019	2,847,101	13.22
Options granted	5,000	29.03
Options exercised	(767,792)	5.05		$	25,066	(1)
Options forfeited	(129,066)	20.20
Outstanding at December 31, 2020	1,955,243	16.01
Options granted	46,000	58.07
Options exercised	(522,495)	12.60		$	24,455	(1)
Options forfeited	(50,856)	29.64
Outstanding at December 31, 2021	1,427,892	$	18.13	$	54,190	(2)
Options exercisable at December 31, 2021	917,909	$	15.62	$	37,064	(2)

_____________________________________________

(1) Represents the total difference between the Company’s closing stock price at the time of exercise and the stock option exercise price, multiplied by the number of options exercised.

Schedule of Restricted Shares Awards and Restricted Stock Units Activity

The following table summarizes restricted shares awards activity:


	Number of Restricted Shares Awards	Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2018	50,000	$	14.48
Restricted shares awards granted	580,667	24.08
Restricted shares awards vested	(27,551)	18.80
Restricted shares awards forfeited	(16,950)	21.09
Outstanding at December 31, 2019	586,166	23.59
Restricted shares awards granted	502,500	37.68
Restricted shares awards vested	(174,890)	23.29
Restricted shares awards forfeited	(96,593)	28.83
Outstanding at December 31, 2020	817,183	31.70
Restricted shares awards granted	638,936	57.90
Restricted shares awards vested	(235,560)	31.19
Restricted shares awards forfeited	(118,525)	40.33
Outstanding at December 31, 2021	1,102,034	$	46.07

The following table summarizes restricted stock units activity:


	Number of Restricted Stock Units	Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2018	—	$	—
Restricted stock units granted	248,104	21.48
Outstanding at December 31, 2019	248,104	21.48
Restricted stock units granted	8,000	29.03
Restricted stock units vested	(46,336)	14.19
Restricted stock units forfeited	(2,667)	14.19
Outstanding at December 31, 2020	207,101	23.49
Restricted stock units granted	212,417	43.62
Restricted stock units vested	(169,054)	19.89

Outstanding at December 31, 2021	250,464	$	42.99

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Schedule of Net Loss (Income) before Income Tax, Domestic and Foreign

The components of net loss (income) before income tax expense were as follows (in thousands):


	Years Ended December 31,
	2021		2020		2019
Domestic	$	(56,105)	$	(54,994)	$	(80,322)
Foreign	(23,180)		80		388
Total	$	(79,285)	$	(54,914)	$	(79,934)

Schedule of Components of Income Tax Expense (Benefit)

The components of the income tax expense (benefit) were as follows (in thousands):


	Years Ended December 31,
	2021		2020		2019
Current:
Federal	$	—	$	—	$	—
State	211		1		1
Foreign	26		—		—
Total current income tax expense	$	237	$	1	$	1
Deferred:
Federal	$	(422)	$	—	$	—
State	(117)		—		—
Foreign	1,084		—		—
Total deferred income tax expense	$	545	$	—	$	—
Total	$	782	$	1	$	1

Schedule of Effective Income Tax Rate Reconciliation

The reconciliation between the Company’s effective tax rate and the statutory tax rate is as follows:


	Years Ended December 31,
	2021		2020		2019
Tax at statutory federal rate	21.0	%	21.0	%	21.0	%
State tax, net of federal benefit	3.8	%	7.0	%	7.0	%
Excess tax benefits related to stock-based compensation	9.4	%	10.3	%	(1.0)	%
Non-deductible stock-based compensation	(1.4)	%	—	%	—	%
Tax rate change	(5.2)	%	—	%	—	%
Net operating loss adjustments	(7.9)	%	—	%	—	%
Section 382 limitation	—	%	—	%	(5.0)	%
R&D tax credit, net of reserve	6.1	%	(4.5)	%	—	%
Change in valuation allowance	(24.5)	%	(36.8)	%	(21.5)	%
Other	(2.3)	%	3.0	%	(0.5)	%
Effective tax rate	(1.0)	%	—	%	—	%

Schedule of Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities are as follows (in thousands) as of:


	December 31,
	2021		2020
Deferred Tax Assets:
Share-based compensation	$	5,367	$	592
Depreciation and amortization	7		145
Lease liability	895		901
Net operating loss carryforwards	74,744		59,176
Research and development credit carryforwards	4,865		—
Interest expense limitation carryforwards	2,518		—
Other	2,895		4,438
Total deferred tax assets	91,291		65,252
Less: valuation allowance	(85,061)		(65,252)
Total net deferred tax assets	$	6,230	$	—

Deferred Tax Liabilities:
Intangibles	$	(25,447)	$	—
Total deferred tax liabilities	$	(25,447)	$	—

Net deferred tax liabilities	$	(19,217)	$	—

Schedule of Unrecognized Tax Benefits Roll Forward

A reconciliation of the beginning and ending balances of unrecognized tax benefits is as follows (in thousands):


Balance at December 31, 2019	$	—
Deductions based on tax positions related to prior years	—
Additions based on tax positions related to the current year	2,491
Balance at December 31, 2020	2,491
Additions based on tax positions related to the current year	528

Additions from business combination	1,782
Deductions for tax positions taken in prior years	(1,397)
Balance at December 31, 2021	$	3,404

Acquisition (Tables)

12 Months Ended

Dec. 31, 2021

Business Combination and Asset Acquisition [Abstract]

Schedule of Allocation of Total Purchase Consideration


	Purchase Price Allocation
Assets Acquired
Cash and cash equivalents	$	593
Accounts receivable	1,688
Inventory	988
Prepaid expenses and other current assets	115
Property and equipment	52
Other assets	108
Intangible assets	112,200
Total assets acquired	115,744
Liabilities Assumed
Accounts payable	209
Accrued liabilities	820
Accrued compensation and benefits	315
Lease liability	86
Debt	122
Deferred tax liabilities	19,286
Total liabilities assumed	20,838

Net assets acquired	94,906
Purchase price consideration	204,692
Goodwill	$	109,786

Schedule of Intangible Assets Acquired


	Fair Value (in thousands)		Useful Life
Technology	$	81,100	12 years
Trade names and trademarks	$	19,700	Indefinite
Customer relationships	$	11,400	12 years

Schedule of Pro Forma Information


	Years Ended December 31,
	2021		2020
Net revenue	$	181,643	$	122,444
Net loss	$	(77,535)	$	(63,183)
Net loss per share, basic and diluted	$	(1.79)	$	(1.66)
Weighted-average shares used to compute basic and diluted net loss per share	43,237,536		38,077,918

The unaudited pro forma financial information above reflects the following pro forma adjustments:

Nature of Operations and Summary of Significant Accounting Policies - Narrative (Details)						3 Months Ended	12 Months Ended
	May 14, 2021 USD ($) $ / shares shares	Mar. 02, 2021 USD ($) shares	Feb. 25, 2021 USD ($)	May 12, 2020 USD ($) $ / shares shares	Nov. 22, 2019 USD ($) $ / shares shares	Jun. 30, 2021 USD ($)	Dec. 31, 2021 USD ($) segment $ / shares shares	Dec. 31, 2020 USD ($) $ / shares shares	Dec. 31, 2019 USD ($) shares	Dec. 31, 2013 USD ($) shares
Revenue Recognition:
Allowance for product returns							$ 200,000	$ 300,000
Replacement costs							200,000	100,000	$ 0
Warranty liability							100,000	100,000
Fair Value of Financial Instruments
Increase in contingent consideration							2,740,000	0	0
Investment Securities:
Unrealized gains (losses) on available-for-sale securities							0	0	0
Outstanding investment securities							0	0
Inventory:
Finished goods inventory							46,800,000	42,100,000
Work-in-process inventory							2,800,000	3,500,000
Raw materials inventory							15,300,000	17,500,000
Inventory reserves							200,000	$ 0
Goodwill:
Impairment charges related to goodwill							0
Intangible Asset:
Issuance of common stock for intagnible asset							3,637,000
Impairment of finite-lived intangible asset							$ 0
Common stock, par value (USD per share) \| $ / shares							$ 0.0001	$ 0.0001
Advertising Expense:
Advertising expense							$ 7,800,000	$ 2,900,000	$ 2,600,000
Stock-Based Compensation:
Requisite service period of recognition of compensation cost							4 years
Net Loss per Share of Common Stock:
Potentially dilutive weighted-average shares not included in computation of diluted weighted-average shares (in shares) \| shares							2,444,444	2,300,982	1,737,430
Segment Reporting [Abstract]
Number of operating segments \| segment							1
Patent license asset
Intangible Asset:
Issuance of common stock for intangible asset (in shares) \| shares										50,000
Issuance of common stock for intagnible asset										$ 1,000,000
Finite-lived intangible asset acquired										$ 1,000,000
Finite-lived intangible assets, weighted-average amortization period										8 years 8 months 15 days
Impairment of finite-lived intangible asset							$ 0
Exclusive license asset
Intangible Asset:
Finite-lived intangible asset acquired		$ 3,300,000
Finite-lived intangible assets, weighted-average amortization period							4 years
Vendor credit in accounts payable		$ 300,000
Contura
Fair Value of Financial Instruments
Contingent consideration at fair value			$ 7,600,000
Intangible Asset:
Finite-lived intangible assets, weighted-average amortization period			12 years
Contura \| Contingent Consideration Liability
Fair Value of Financial Instruments
Contingent consideration at fair value			$ 6,800,000			$ 7,600,000	$ 10,400,000
Increase in contingent consideration						$ 800,000	$ 2,700,000
Minimum
Inventory:
Inventory shelf life							12 months
Property and Equipment:
Property and equipment useful life							3 years
Maximum
Inventory:
Inventory shelf life							36 months
Property and Equipment:
Property and equipment useful life							7 years
Common Stock Issued upon Exercise of Underwriters Option
May 2019 to 2021 Follow-On Offering:
Stock issued (shares) \| shares	525,000			600,000	750,000
Follow-on Offering
May 2019 to 2021 Follow-On Offering:
Stock issued (shares) \| shares	4,025,000			4,600,000	5,345,000
Sale of stock, stock price (USD per share) \| $ / shares	$ 50.00			$ 32.50	$ 22.00
Net proceeds from sale of stock	$ 190,000,000			$ 140,500,000	$ 110,400,000
Common Stock
Intangible Asset:
Issuance of common stock for intangible asset (in shares) \| shares							65,594
Common Stock \| Exclusive license asset
Intangible Asset:
Issuance of common stock for intangible asset (in shares) \| shares		65,594
Issuance of common stock for intagnible asset		$ 3,600,000
Stock Option and Restricted Stock-Based Awards
Stock-Based Compensation:
Vesting period							4 years
Restricted Stock Units
Stock-Based Compensation:
Vesting period							1 year

Nature of Operations and Summary of Significant Accounting Policies - Revenue by Geographic Market (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Net revenue	$ 24,100	$ 111,535	$ 13,820
Sacral Neuromodulation
Disaggregation of Revenue [Line Items]
Net revenue	157,590	111,535	13,820
Bulkamid
Disaggregation of Revenue [Line Items]
Net revenue	22,700	0	0
United States \| Sacral Neuromodulation
Disaggregation of Revenue [Line Items]
Net revenue	153,837	107,542	8,376
United States \| Bulkamid
Disaggregation of Revenue [Line Items]
Net revenue	12,660	0	0
International markets \| Sacral Neuromodulation
Disaggregation of Revenue [Line Items]
Net revenue	3,753	3,993	5,444
International markets \| Bulkamid
Disaggregation of Revenue [Line Items]
Net revenue	$ 10,040	$ 0	$ 0

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9038-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Nature of Operations and Summary of Significant Accounting Policies - Changes in Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 465	$ 75	$ 0
Write-offs	12	0	0
Bad debt (recoveries) expense	(122)	390	75
Balance at end of period	$ 355	$ 465	$ 75

Nature of Operations and Summary of Significant Accounting Policies - Schedule of Changes in Fair Value of Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Contingent consideration:
Change in fair value included in earnings	$ 2,740	$ 0	$ 0
Level 3 \| Contingent Consideration Liability \| Fair Value, Recurring
Contingent consideration:
Balance at beginning of period	0
February 25, 2021 Acquisition	7,630
Change in fair value included in earnings	2,740
Balance at end of period	$ 10,370	$ 0

Property and Equipment - Summary (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 12,459	$ 10,143
Less: accumulated depreciation and amortization	(5,544)	(3,815)
Property and equipment, net	6,915	6,328
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	2,429	1,205
Computer hardware and software
Property, Plant and Equipment [Line Items]
Property and equipment, gross	2,450	2,286
Tools and molds
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,579	1,404
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	4,372	3,759
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,502	1,360
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 127	$ 129

Property and Equipment - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Depreciation and amortization expense	$ 9,126	$ 1,741	$ 1,191
Property and Equipment
Property, Plant and Equipment [Line Items]
Depreciation and amortization expense	$ 1,900	$ 1,600	$ 1,100

Goodwill and Intangible Assets - Schedule of Carrying Amount of Goodwill (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 0
February 25, 2021 Acquisition	109,786
Foreign currency translation adjustment	(4,276)
Goodwill, closing Balance	$ 105,510

Goodwill and Intangible Assets - Schedule of Finite-Lived and Indefinite-Lived Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets, Net:
Accumulated Amortization	$ (8,046)
Foreign currency translation adjustment	(1,985)
Intangible Assets, Net (Excluding Goodwill):
Gross Carrying Amount	116,500
Accumulated Amortization	(8,046)
Foreign currency translation adjustment	(1,985)
Intangible Assets, Net	106,469	$ 196
Trade names and trademarks
Indefinite-lived Intangible Assets:
Gross Carrying Amount	19,700
Foreign currency translation adjustment	(365)
Intangible Assets, Net	$ 19,335
Patent license asset
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period	8 years 8 months 15 days
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 1,000	1,000
Accumulated Amortization	(919)	(804)
Foreign currency translation adjustment	0	0
Intangible Assets, Net	81	196
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	(919)	(804)
Foreign currency translation adjustment	$ 0	$ 0
Exclusive license asset
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period	4 years
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 3,300
Accumulated Amortization	(660)
Foreign currency translation adjustment	0
Intangible Assets, Net	2,640
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	(660)
Foreign currency translation adjustment	$ 0
Technology
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period	12 years
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 81,100
Accumulated Amortization	(5,668)
Foreign currency translation adjustment	(1,424)
Intangible Assets, Net	74,008
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	(5,668)
Foreign currency translation adjustment	$ (1,424)
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period	12 years
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 11,400
Accumulated Amortization	(799)
Foreign currency translation adjustment	(196)
Intangible Assets, Net	10,405
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	(799)
Foreign currency translation adjustment	$ (196)

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 7,241	$ 115	$ 115

Goodwill and Intangible Assets - Estimated Future Amortization Expense (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Finite-Lived Intangible Assets, Amortization Expense, Maturity Schedule [Abstract]
2022	$ 9,326
2023	9,138
2024	9,011
2025	7,970
2026	$ 7,820

Commitments and Contingencies - Narrative (Details)		12 Months Ended
Commitments and Contingencies - Narrative (Details)	Mar. 16, 2020 petition	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Aug. 31, 2020 ft²	Jun. 30, 2019 ft²	Nov. 30, 2017 ft²	Aug. 31, 2014 ft²
Loss Contingencies [Line Items]
Right-of-use assets obtained in exchange for operating lease liabilities		$ 1,000,000	$ 3,800,000	$ 1,500,000
Right-of-use asset		$ 7,100,000	$ 7,100,000
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]		Other assets	Other assets
Operating lease payments		$ 2,000,000	$ 1,500,000	900,000
Operating lease ROU asset amortization		$ 1,000,000	$ 900,000	400,000
Weighted-average remaining lease term for operating leases		5 years 10 months 24 days	6 years 7 months 6 days
Discount rate on operating lease (as a percent)		7.10%	6.70%
Period after first sale royalty is due		12 years
Net revenue due as royalty (as a percent)		4.00%
Revenues		$ 24,100,000	$ 111,535,000	13,820,000
Royalty expense		6,300,000	4,400,000	600,000
Accrued royalty		1,800,000	1,400,000
Sacral Neuromodulation
Loss Contingencies [Line Items]
Revenues		157,590,000	$ 111,535,000	$ 13,820,000
Medtronic Litigation
Loss Contingencies [Line Items]
Number of petitions filed with the United States Patent and Trademark Office \| petition	7
Number of petitions accepted by the United States Patent and Trademark Office \| petition	6
Minimum number of claims by Medtronic that are invalid as determined by the United States Patent and Trademark Office \| petition	1
Maximum
Loss Contingencies [Line Items]
Royalty commitments		$ 200,000
First Lease
Loss Contingencies [Line Items]
Term of operating lease contract								5 years
Net rentable area (square feet) \| ft²								12,215
Second Lease
Loss Contingencies [Line Items]
Term of operating lease contract							7 years
Net rentable area (square feet) \| ft²							25,548
Operating lease renewal term of contract							5 years
Third Lease
Loss Contingencies [Line Items]
Term of operating lease contract						8 years
Net rentable area (square feet) \| ft²						32,621
Operating lease renewal term of contract						5 years
Fourth Lease
Loss Contingencies [Line Items]
Term of operating lease contract					38 months
Net rentable area (square feet) \| ft²					5,693

Commitments and Contingencies - Total Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Operating lease cost	$ 2,107	$ 1,991	$ 1,031
Short-term lease cost	95	95	177
Variable lease cost	191	179	138
Total lease cost	$ 2,393	$ 2,265	$ 1,346

Commitments and Contingencies - Future Minimum Lease Payments for Operating Lease (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
2022	$ 2,063
2023	2,094
2024	2,066
2025	2,150
2026	2,239
Thereafter	2,280
Total lease payments	12,892
Less: imputed interest	(2,474)
Operating lease liability	10,418
Less: operating lease liability, current portion	(1,366)	$ (1,280)
Operating lease liability, net of current portion	$ 9,052	$ 9,154

Long-Term Debt - Narrative (Details) - USD ($) $ in Millions		12 Months Ended
	Feb. 28, 2021	Dec. 31, 2021	Mar. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Voting capital stock of foreign subsidiaries excluded from first priority lien (more than) (as a percent)		65.00%
Term Loan One \| Term Loans
Debt Instrument [Line Items]
Interest expense		$ 0.4
Unamortized debt issuance costs				$ 0.4
Loan and Security Agreement \| Term Loans
Debt Instrument [Line Items]
Face amount of debt instrument	$ 75.0
Stated interest rate (as a percent)	9.00%
Final payment fee (as a percent)	6.00%
Period of prior written notice before prepayment of amounts outstanding	5 days
Interest rate increase in case of default (as a percent)	5.00%
Loan and Security Agreement \| Term Loans \| Period One
Debt Instrument [Line Items]
Prepayment fee (as a percent)	2.00%
Loan and Security Agreement \| Term Loans \| Period Two
Debt Instrument [Line Items]
Prepayment fee (as a percent)	1.00%
Loan and Security Agreement \| Term Loans \| Prime Rate
Debt Instrument [Line Items]
Basis spread on variable rate (as a percent)	5.75%
Term Loan Two \| Term Loans
Debt Instrument [Line Items]
Interest expense		$ 4.4
Unamortized debt issuance costs			$ 4.4

Stockholders' Equity - Preferred Stock Narrative (Details) - $ / shares	Dec. 31, 2021	Dec. 31, 2020
Equity [Abstract]
Preferred stock authorized (shares)	10,000,000	10,000,000
Preferred stock, par value (USD per share)	$ 0.0001	$ 0.0001

Stockholders' Equity - Common Stock Narrative (Details)	Dec. 31, 2021 vote
Common Stock
Class of Stock [Line Items]
Number of votes per share	1

Stockholders' Equity - Stock-based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 25,164	$ 15,095	$ 8,720
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	5,980	3,457	1,725
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	8,079	5,852	3,950
Sales and marketing
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 11,105	$ 5,786	$ 3,045

Stockholders' Equity - Stock Option Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options grants in period, weighted average grant date fair value (USD per share)	$ 32.93	$ 18.56	$ 13.79
Options outstanding weighted average remaining contractual term	6 years 10 months 24 days	7 years 8 months 12 days
Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 6.7	$ 11.6
Unrecognized compensation cost, period for recognition	1 year 7 months 6 days	2 years 4 months 24 days
2014 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock reserved for issuance (shares)	3,130,064	3,131,624
Options and restricted stock-based awards remaining for future issuance (shares)	0	0
2018 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock reserved for issuance (shares)	4,588,548
Options and restricted stock-based awards remaining for future issuance (shares)	950,354	1,678,326

Stockholders' Equity - Common Stock Reserved for Future Issuance (Details) - shares	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock-based awards outstanding (shares)	1,427,892	1,955,243	2,847,101	1,514,347
Common stock reserved for future issuance (shares)	3,730,744	4,657,853
2014 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock-based awards remaining for future issuance (shares)	0	0
2018 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock-based awards remaining for future issuance (shares)	950,354	1,678,326
Stock Option \| 2014 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock-based awards outstanding (shares)	277,505	501,598
Stock Option and Restricted Stock-Based Awards \| 2018 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock-based awards outstanding (shares)	2,502,885	2,477,929
Options and restricted stock-based awards remaining for future issuance (shares)	950,354	1,678,326

Stockholders' Equity - Fair Value Assumptions (Details)	12 Months Ended
Stockholders' Equity - Fair Value Assumptions (Details)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected term (in years)		6 years 18 days
Stock volatility, minimum (as a percent)	63.49%	72.01%	70.02%
Stock volatility, maximum (as a percent)	63.49%	72.01%	77.52%
Risk-free interest rate, minimum (as a percent)	0.53%	1.37%	1.42%
Risk-free interest rate, maximum (as a percent)	1.16%	1.37%	2.56%
Dividend rate (as a percent)	0.00%	0.00%	0.00%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected term (in years)	5 years 5 months 15 days		5 years 25 days
Maximum
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions and Methodology [Abstract]
Expected term (in years)	6 years		6 years 1 month 28 days

Stockholders' Equity - Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Number of Options
Outstanding at beginning of period (shares)	1,955,243	2,847,101	1,514,347
Options granted (shares)	46,000	5,000	1,671,044
Options exercised (shares)	(522,495)	(767,792)	(281,744)
Options forfeited (shares)	(50,856)	(129,066)	(56,546)
Outstanding at end of period (shares)	1,427,892	1,955,243	2,847,101
Options exercisable (shares)	917,909
Weighted-Average Exercise Price Per Share
Outstanding at beginning of period (USD per share)	$ 16.01	$ 13.22	$ 2.22
Options granted (USD per share)	58.07	29.03	21.28
Options exercised (USD per share)	12.60	5.05	1.79
Options forfeited (USD per share)	29.64	20.20	13.43
Outstanding at end of period (USD per share)	18.13	$ 16.01	$ 13.22
Options exercisable (USD per share)	$ 15.62
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract]
Options exercised intrinsic value	$ 24,455	$ 25,066	$ 7,386
Options outstanding intrinsic value	54,190
Options exercisable intrinsic value	$ 37,064

Stockholders' Equity - Restricted Shares Award Narrative (Details) - Restricted Shares Awards - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 42.5	$ 22.6
Unrecognized compensation cost, period for recognition	3 years	3 years 3 months 18 days

Stockholders' Equity - Restricted Shares Awards Activity (Details) - Restricted Shares Awards - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Number of Restricted Shares Awards
Outstanding at beginning of period (shares)	817,183	586,166	50,000
Granted (shares)	638,936	502,500	580,667
Vested (shares)	(235,560)	(174,890)	(27,551)
Forfeited (shares)	(118,525)	(96,593)	(16,950)
Outstanding at end of period (shares)	1,102,034	817,183	586,166
Weighted-Average Fair Value Per Share at Grant Date
Outstanding at beginning of period (USD per share)	$ 31.70	$ 23.59	$ 14.48
Granted (USD per share)	57.90	37.68	24.08
Vested (USD per share)	31.19	23.29	18.80
Forfeited (USD per share)	40.33	28.83	21.09
Outstanding at end of period (USD per share)	$ 46.07	$ 31.70	$ 23.59

Stockholders' Equity - Restricted Stock Units Narrative (Details) - Restricted Stock Units - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 1.9	$ 1.2
Unrecognized compensation cost, period for recognition	10 months 24 days	10 months 24 days

Stockholders' Equity - Restricted Stock Units Activity (Details) - Restricted Stock Units - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Number of Restricted Stock Units
Outstanding at beginning of period (shares)	207,101	248,104	0
Granted (shares)	212,417	8,000	248,104
Vested (shares)	(169,054)	(46,336)
Forfeited (shares)		(2,667)
Outstanding at end of period (shares)	250,464	207,101	248,104
Weighted-Average Fair Value Per Share at Grant Date
Outstanding at beginning of period (USD per share)	$ 23.49	$ 21.48	$ 0
Granted (USD per share)	43.62	29.03	21.48
Vested (USD per share)	19.89	14.19
Forfeited (USD per share)		14.19
Outstanding at end of period (USD per share)	$ 42.99	$ 23.49	$ 21.48

Stockholders' Equity - Stock Warrants (Details) - Warrants - $ / shares	Jul. 16, 2019	May 29, 2019	Dec. 31, 2021	Dec. 31, 2020
Class of Warrant or Right [Line Items]
Warrants issued (shares)	32,529	31,071
Warrants exercised (shares)	40,000	40,000
Exercise price of warrants (USD per share)	$ 7.50	$ 7.50
Warrants outstanding (shares)			0	0

Income Taxes - Income (Loss) Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Domestic	$ (56,105)	$ (54,994)	$ (80,322)
Foreign	(23,180)	80	388
Loss before income tax expense	$ (79,285)	$ (54,914)	$ (79,934)

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (f)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 940
-SubTopic 20
-Section 25
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=123384075&loc=d3e41242-110953

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(10))
-URI http://asc.fasb.org/extlink&oid=123367319&loc=SL114868664-224227

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(8))
-URI http://asc.fasb.org/extlink&oid=120400993&loc=SL114874131-224263

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 235
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-URI http://asc.fasb.org/extlink&oid=120399901&loc=d3e537907-122884

Reference 9: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8924-108599

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-URI http://asc.fasb.org/extlink&oid=120399700&loc=SL114874048-224260

+ Details

Income Taxes - Provision For Current And Deferred Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Current:
Federal	$ 0	$ 0	$ 0
State	211	1	1
Foreign	26	0	0
Total current income tax expense	237	1	1
Deferred:
Federal	(422)	0	0
State	(117)	0	0
Foreign	1,084	0	0
Total deferred income tax expense	545	0	0
Income tax expense	$ 782	$ 1	$ 1

Income Taxes - Effective Income Tax Rate Reconciliation (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Tax at statutory federal rate (as a percent)	21.00%	21.00%	21.00%
State tax, net of federal benefit (as a percent)	3.80%	7.00%	7.00%
Excess tax benefits related to stock-based compensation (as a percent)	9.40%	10.30%	(1.00%)
Non-deductible stock-based compensation (as a percent)	(1.40%)	0.00%	0.00%
Tax rate change (as a percent)	(5.20%)	0.00%	0.00%
Net operating loss adjustments (as a percent)	(7.90%)	0.00%	0.00%
Section 382 limitation (as a percent)	0.00%	0.00%	(5.00%)
R&D tax credit, net of reserve (as a percent)	6.10%	(4.50%)	0.00%
Change in valuation allowance (as a percent)	(24.50%)	(36.80%)	(21.50%)
Other (as a percent)	(2.30%)	3.00%	(0.50%)
Effective tax rate (as a percent)	(1.00%)	0.00%	0.00%

Income Taxes - Narrative (Details) - USD ($)	12 Months Ended
Income Taxes - Narrative (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Contingency [Line Items]
Annual effective tax rate (as a percent)	(1.00%)	0.00%	0.00%
Increase (decrease) in valuation allowance	$ 19,800,000
Valuation allowance	85,061,000	$ 65,252,000
Reduction in net operating loss carryforwards		12,200,000
Unrecognized tax benefits	3,404,000	2,491,000	$ 0
Unrecognized tax benefits that would impact effective tax rate	100,000
Unrecognized tax benefits subject to indemnification	1,700,000
Unrecognized tax benefits accumulated interest and penalties	400,000
Interest or penalties to be recognized for the period		0	$ 0
Domestic Tax Authority
Income Tax Contingency [Line Items]
Operating loss carryforwards	258,200,000
Operating loss carryforwards, subject to expiration	51,500,000
Foreign Tax Authority
Income Tax Contingency [Line Items]
Operating loss carryforwards	16,400,000
State and Local Tax Authority
Income Tax Contingency [Line Items]
Operating loss carryforwards, subject to expiration	$ 245,600,000
Research Tax Credit Carryforward
Income Tax Contingency [Line Items]
Reduction in R&D tax credits		$ 1,500,000

Income Taxes - Net Deferred Tax Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred Tax Assets:
Share-based compensation	$ 5,367	$ 592
Depreciation and amortization	7	145
Lease liability	895	901
Net operating loss carryforwards	74,744	59,176
Research and development credit carryforwards	4,865	0
Interest expense limitation carryforwards	2,518	0
Other	2,895	4,438
Total deferred tax assets	91,291	65,252
Less: valuation allowance	(85,061)	(65,252)
Total net deferred tax assets	6,230	0
Deferred Tax Liabilities:
Intangibles	(25,447)	0
Total deferred tax liabilities	(25,447)	0
Net deferred tax liabilities	$ (19,217)	$ 0

Income Taxes - Reconciliation of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at beginning of period	$ 2,491	$ 0
Deductions based on tax positions related to prior years	(1,397)	0
Additions based on tax positions related to the current year	528	2,491
Additions from business combination	1,782
Balance at end of period	$ 3,404	$ 2,491

Employee Benefit Plan - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Contributions by employer	$ 1.9	$ 1.6	$ 1.1

Acquisition - Narrative (Details) - USD ($)		3 Months Ended			10 Months Ended	12 Months Ended
Acquisition - Narrative (Details) - USD ($)	Feb. 25, 2021	Dec. 31, 2021	Sep. 30, 2021	Jun. 30, 2021	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Amortization of intangible assets						$ 7,241,000	$ 115,000	$ 115,000
Goodwill		$ 105,510,000			$ 105,510,000	105,510,000	0
Increase in contingent consideration						2,740,000	0	0
Revenues						24,100,000	111,535,000	13,820,000
Net loss						2,800,000	$ 54,915,000	$ 79,935,000
Contura
Business Acquisition [Line Items]
Equity interest acquired (as a percent)	100.00%
Purchase price consideration	$ 204,692,000
Upfront consideration paid in cash	141,400,000
Stock consideration transferred	$ 55,700,000
Upfront consideration, stock transferred as part of acquisition (shares)	1,096,583
Maximum contingent consideration	$ 35,000,000
Amount of sales to achieve for maximum contingent consideration	50,000,000
Potential future milestone payment as part of acquisition	7,600,000
Amortization of intangible assets						6,500,000
Balance of intangible assets acquired, net	$ 112,200,000	103,700,000			103,700,000	103,700,000
Finite-lived intangible assets, weighted-average amortization period	12 years
Goodwill	$ 109,786,000
Deferred tax liabilities	19,286,000
Acquisition-related costs	4,400,000
Revenue of acquiree since acquisition date					22,700,000
Net loss of acquiree since acquisition date					2,200,000
Contura \| Contingent Consideration Liability
Business Acquisition [Line Items]
Potential future milestone payment as part of acquisition	$ 6,800,000	10,400,000		$ 7,600,000	10,400,000	10,400,000
Increase in contingent consideration				800,000		2,700,000
Increase (decrease) in goodwill				800,000
Contura \| Deferred Tax Liability
Business Acquisition [Line Items]
Increase (decrease) in goodwill		(4,500,000)	$ 5,900,000	17,900,000
Deferred tax liabilities		19,300,000	23,800,000	$ 17,900,000	$ 19,300,000	$ 19,300,000
Increase (decrease) in deferred liabilities		$ (4,500,000)	$ 5,900,000

Acquisition - Schedule of Preliminary Allocation of Total Purchase Consideration (Details) - USD ($) $ in Thousands	Feb. 25, 2021	Dec. 31, 2021	Dec. 31, 2020
Liabilities Assumed
Goodwill		$ 105,510	$ 0
Contura
Assets Acquired
Cash and cash equivalents	$ 593
Accounts receivable	1,688
Inventory	988
Prepaid expenses and other current assets	115
Property and equipment	52
Other assets	108
Intangible assets	112,200	$ 103,700
Total assets acquired	115,744
Liabilities Assumed
Accounts payable	209
Accrued liabilities	820
Accrued compensation and benefits	315
Lease liability	86
Debt	122
Deferred tax liabilities	19,286
Total liabilities assumed	20,838
Net assets acquired	94,906
Purchase price consideration	204,692
Goodwill	$ 109,786

Acquisition - Schedule of Intangible Assets Acquired (Details) - Contura $ in Thousands	Feb. 25, 2021 USD ($)
Business Acquisition [Line Items]
Useful Life	12 years
Trade names and trademarks
Business Acquisition [Line Items]
Fair value of indefinite-lived intangibles acquired	$ 19,700
Technology
Business Acquisition [Line Items]
Fair value of finite-lived intangibles acquired	$ 81,100
Useful Life	12 years
Customer relationships
Business Acquisition [Line Items]
Fair value of finite-lived intangibles acquired	$ 11,400
Useful Life	12 years

Acquisition - Schedule of Pro Forma Information (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition, Pro Forma Information [Abstract]
Net loss per share, basic (USD per share)	$ (1.79)	$ (1.66)
Net loss per share, diluted (USD per share)	$ (1.79)	$ (1.66)
Weighted-average shares used to compute basic net loss per share (in shares)	43,237,536	38,077,918
Weighted-average shares used to compute diluted net loss per share (in shares)	43,237,536	38,077,918
Contura
Business Acquisition, Pro Forma Information [Abstract]
Net revenue	$ 181,643	$ 122,444
Net loss	(77,535)	(63,183)
Contura \| Acquisition-related costs
Business Acquisition, Pro Forma Information [Abstract]
Net loss	4,400	(4,400)
Contura \| Fair value adjustment to intangible assets
Business Acquisition, Pro Forma Information [Abstract]
Net loss	$ (1,300)	(7,800)
Contura \| Fair value adjustment for deferred tax liabilities
Business Acquisition, Pro Forma Information [Abstract]
Net loss		$ 2,200