0001603756-24-000036 | 10-K | XBRL Viewer

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Stockholders' Equity - Schedule of Restricted Shares Awards Activity (Details) - Restricted Shares Awards - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Number of Restricted Shares Awards
Outstanding at beginning of period (in shares)	1,320,866	1,102,034	817,183
Restricted shares awards granted (in shares)	635,766	683,354	638,936
Restricted shares awards vested (in shares)	(540,441)	(351,946)	(235,560)
Restricted shares awards forfeited (in shares)	(112,487)	(112,576)	(118,525)
Outstanding at end of period (in shares)	1,303,704	1,320,866	1,102,034
Weighted-Average Fair Value Per Share at Grant Date
Outstanding at beginning of period (in USD per share)	$ 52.23	$ 46.07	$ 31.70
Restricted shares awards granted (in USD per share)	57.28	56.69	57.90
Restricted shares awards vested (in USD per share)	48.86	42.15	31.19
Restricted shares awards forfeited (in USD per share)	54.88	50.50	40.33
Outstanding at end of period (in USD per share)	$ 55.86	$ 52.23	$ 46.07

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

The change in the carrying amount of goodwill during the years ended December 31, 2023 and 2022 included the following (in thousands):


December 31, 2021	$	105,510

Foreign currency translation adjustment	(11,096)
December 31, 2022	94,414
Foreign currency translation adjustment	5,003
December 31, 2023	$	99,417

Intangible assets as of December 31, 2023 included the following (in thousands):


		December 31, 2023
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization		Impairment		Foreign currency translation adjustment		Intangible Assets, Net
Patent license asset	8.71 years	$	1,000	$	(1,000)	$	—	$	—	$	—
Exclusive license asset	4 years	3,300		(2,420)		—		—		880
Technology	12 years	81,100		(19,236)		—		(6,140)		55,724
Trade names and trademarks	Indefinite	19,700		—		—		(1,482)		18,218
Customer relationships	12 years	11,400		(3,837)		(287)		(723)		6,553
		$	116,500	$	(26,493)	$	(287)	$	(8,345)	$	81,375

Intangible asset as of December 31, 2022 included the following (in thousands):


		December 31, 2022
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization		Impairment		Foreign currency translation adjustment		Intangible Assets, Net
Patent license asset	8.71 years	$	1,000	$	(1,000)	$	—	$	—	$	—
Exclusive license asset	4 years	3,300		(1,540)		—		—		1,760
Technology	12 years	81,100		(12,496)		—		(9,141)		59,463
Trade names and trademarks	Indefinite	19,700		—		—		(2,398)		17,302
Customer relationships	12 years	11,400		(2,393)		(287)		(992)		7,728
		$	116,500	$	(17,429)	$	(287)	$	(12,531)	$	86,253

The Company recorded expense for the amortization of intangible assets of $9.1 million, $9.4 million, and $7.2 million, respectively, during the years ended December 31, 2023, 2022, and 2021. The estimated future amortization expense as of December 31, 2023, is as follows (in thousands):


2024	$	8,962
2025	7,927
2026	7,783
2027	7,645
2028	7,512

Stockholders' Equity - Schedule of Common Stock Reserved for Future Issuance (Details) - shares	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock units outstanding (in shares)	814,780	1,046,610	1,427,892	1,955,243
Common stock reserved for future issuance (shares)	2,965,640	3,924,650
2014 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock-based awards remaining for future issuance (in 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 (in shares)	1,920,160
Stock Option \| 2014 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock units outstanding (in shares)	160,863	184,104
Stock Option and Restricted Stock-Based Awards \| 2018 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock units outstanding (in shares)	884,617	1,045,924
Options and restricted stock-based awards remaining for future issuance (in shares)	1,920,160	2,694,622

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

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+ Details

Stockholders' Equity - Schedule of Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Number of Options
Outstanding at beginning of period (in shares)	1,046,610	1,427,892	1,955,243
Options granted (in shares)	0	0	46,000
Options exercised (in shares)	(219,763)	(364,352)	(522,495)
Options forfeited (in shares)	(12,067)	(16,930)	(50,856)
Outstanding at end of period (in shares)	814,780	1,046,610	1,427,892
Options exercisable (in shares)	810,400
Weighted-Average Exercise Price Per Share
Outstanding at beginning of period (in USD per share)	$ 18.81	$ 18.13	$ 16.01
Options granted (in USD per share)			58.07
Options exercised (in USD per share)	19.34	15.54	12.60
Options forfeited (in USD per share)	31.57	31.80	29.64
Outstanding at end of period (in USD per share)	18.47	$ 18.81	$ 18.13
Options exercisable (in USD per share)	$ 18.25
Aggregate Intrinsic Value
Intrinsic value of options exercised	$ 9,076	$ 18,251	$ 24,455
Intrinsic value of options outstanding	35,652
Intrinsic value of options exercisable	$ 35,642

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Schedule of Stock-based Compensation Expense

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


	Years Ended December 31,
	2023		2022		2021
Research and development	$	9,362	$	6,734	$	5,980
General and administrative	11,687		7,965		8,079
Sales and marketing	23,487		17,319		11,105
	$	44,536	$	32,018	$	25,164

Schedule of Common Stock Reserved for Future Issuance

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


	December 31,
	2023	2022

Options outstanding under the 2014 Plan	160,863	184,104

Options and restricted stock units outstanding under the 2018 Plan	884,617	1,045,924
Options and restricted stock-based awards remaining under the 2018 Plan for future issuance	1,920,160	2,694,622
	2,965,640	3,924,650

Schedule of Stock Option Award Valuation Assumptions

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,
	2023	2022	2021
Expected term (in years)	—	—	5.46 - 6.00
Stock volatility	—	—	63.49%
Risk-free interest rate	—	—	0.53% - 1.16%
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, 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

Options exercised	(364,352)	15.54		$	18,251	(1)
Options forfeited	(16,930)	31.80
Outstanding at December 31, 2022	1,046,610	18.81

Options exercised	(219,763)	19.34		$	9,076	(1)
Options forfeited	(12,067)	31.57
Outstanding at December 31, 2023	814,780	$	18.47	$	35,652	(2)
Options exercisable at December 31, 2023	810,400	$	18.25	$	35,642	(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 2023 and the stock option exercise price, multiplied by the number of in-the-money options as of December 31, 2023. The amount of intrinsic value will change based on the fair market value of the Company’s stock.

Schedule of Restricted Shares Awards and Restricted Stock Units Activity

The following table summarizes RSAs activity:


	Number of Restricted Shares Awards	Weighted-Average Fair Value Per Share at Grant Date
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 shares awards granted	683,354	56.69
Restricted shares awards vested	(351,946)	42.15
Restricted shares awards forfeited	(112,576)	50.50
Outstanding at December 31, 2022	1,320,866	52.23
Restricted shares awards granted	635,766	57.28
Restricted shares awards vested	(540,441)	48.86
Restricted shares awards forfeited	(112,487)	54.88
Outstanding at December 31, 2023	1,303,704	$	55.86

The following table summarizes RSUs activity:


	Number of Restricted Stock Units	Weighted-Average Fair Value Per Share at Grant Date
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
Restricted stock units granted	201,884	38.75
Restricted stock units vested	(268,930)	35.88

Outstanding at December 31, 2022	183,418	48.74
Restricted stock units granted	286,750	65.44
Restricted stock units vested	(215,968)	50.71
Restricted stock units forfeited	(23,500)	$	75.07
Outstanding at December 31, 2023	230,700	$	70.20

Income Taxes - Schedule of Reconciliation of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Balance at beginning of period	$ 2,375	$ 3,404
Additions based on tax positions related to the current year	852	574
Additions based on tax positions related to the prior year	339
Deductions for tax positions taken due to settlement	(83)	(1,603)
Balance at end of period	$ 3,483	$ 2,375

Stockholders' Equity - Schedule of Restricted Stock Units Activity (Details) - Restricted Stock Units - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Number of Restricted Stock Units
Outstanding at beginning of period (in shares)	183,418	250,464	207,101
Restricted stock units granted (in shares)	286,750	201,884	212,417
Restricted stock units vested (in shares)	(215,968)	(268,930)	(169,054)
Restricted stock units forfeited (in shares)	(23,500)
Outstanding at end of period (in shares)	230,700	183,418	250,464
Weighted-Average Fair Value Per Share at Grant Date
Outstanding at beginning of period (in USD per share)	$ 48.74	$ 42.99	$ 23.49
Restricted stock units granted (in USD per share)	65.44	38.75	43.62
Restricted stock units vested (in USD per share)	50.71	35.88	19.89
Restricted stock units forfeited (in USD per share)	75.07
Outstanding at end of period (in USD per share)	$ 70.20	$ 48.74	$ 42.99

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2023
Audit Information [Abstract]
Auditor Name	BDO USA, P.C.
Auditor Location	Costa Mesa, California
Auditor Firm ID	243

Acquisition - Narrative (Details) - USD ($)		3 Months Ended	10 Months Ended	12 Months Ended
Acquisition - Narrative (Details) - USD ($)	Feb. 25, 2021	Jun. 30, 2021	Dec. 31, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Mar. 31, 2021
Business Acquisition [Line Items]
Goodwill			$ 105,510,000	$ 99,417,000	$ 94,414,000	$ 105,510,000
Payment of contingent consideration				27,370,000	0	0
Revenues				366,379,000	273,702,000	180,290,000
Net loss				(6,088,000)	(59,698,000)	(80,067,000)
Contura
Business Acquisition [Line Items]
Revenues						24,100,000
Net loss						(2,800,000)
Contura
Business Acquisition [Line Items]
Equity interest acquired (as a percent)	100.00%
Purchase price consideration	$ 204,692,000
Cash consideration transferred	141,400,000
Stock consideration transferred	$ 55,700,000
Stock transferred in acquisition (in shares)	1,096,583
Maximum contingent consideration	$ 35,000,000
Amount of sales to achieve for maximum contingent consideration	50,000,000
Contingent consideration at fair value	7,600,000
Goodwill	109,786,000
Deferred tax liabilities	19,286,000		19,300,000			$ 19,300,000
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]
Contingent consideration at fair value	$ 6,800,000	$ 7,600,000			$ 32,600,000
Payment of contingent consideration				$ 35,000,000
Increase (decrease) in goodwill		$ 800,000

Commitments and Contingencies - Narrative (Details)	12 Months Ended			24 Months Ended
Commitments and Contingencies - Narrative (Details)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2023 USD ($)	Nov. 01, 2023 USD ($)	Oct. 05, 2023	Apr. 30, 2023 ft²	Mar. 31, 2022 ft²	Aug. 31, 2020 ft²	Jun. 30, 2019 ft²	Aug. 01, 2018 ft²	Aug. 31, 2014 ft²
Loss Contingencies [Line Items]
Right-of-use asset	$ 22,500,000	$ 6,200,000		$ 22,500,000
Right-of-use asset [Extensible List]	Other assets	Other assets		Other assets
Operating lease, liability	$ 27,617,000			$ 27,617,000
Right-of-use assets obtained in exchange for operating lease liabilities	21,900,000	$ 100,000	$ 1,000,000
Cash paid for operating lease liabilities	2,500,000	2,100,000	2,000,000
Amortization of the ROU asset	$ 900,000	$ 1,000,000	1,000,000
Weighted-average remaining lease term for operating leases (in years)	9 years 7 months 6 days	4 years 10 months 24 days		9 years 7 months 6 days
Weighted-average incremental borrowing rate, operating leases’ future payments (as a percent)	5.90%	7.10%		5.90%
Period after first sale royalty is due (in years)	12 years
Net revenue due as royalty (as a percent)	4.00%
Royalty expense	$ 2,500,000	$ 3,300,000	$ 6,300,000
Accrued royalty expense	800,000	$ 600,000		$ 800,000
F15
Loss Contingencies [Line Items]
Net revenue previously received for sales subject to dispute (as a percent)						4.00%
Net revenue subject of dispute with interest amount, held in escrow	$ 12,700,000			$ 16,000,000
Royalty payment (as a percent)	4.00%			4.00%
Maximum
Loss Contingencies [Line Items]
Royalty commitments	$ 200,000			$ 200,000
First Lease
Loss Contingencies [Line Items]
Term of operating lease contract (in years)												5 years
Net rentable area (square feet) \| ft²												12,215
Second Lease
Loss Contingencies [Line Items]
Net rentable area (square feet) \| ft²											25,548
Third Lease
Loss Contingencies [Line Items]
Term of operating lease contract (in years)										8 years
Net rentable area (square feet) \| ft²										32,621
Fourth Lease
Loss Contingencies [Line Items]
Term of operating lease contract (in years)									38 months
Net rentable area (square feet) \| ft²									5,693
Fifth Lease
Loss Contingencies [Line Items]
Term of operating lease contract (in years)								18 months
Net rentable area (square feet) \| ft²								3,276
Sixth Lease
Loss Contingencies [Line Items]
Term of operating lease contract (in years)							120 months
Net rentable area (square feet) \| ft²							145,960
Renewal term of operating lease (in years)							5 years
Right-of-use asset					$ 21,900,000
Operating lease, liability					$ 23,100,000

Income Taxes - Schedule of Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current:
Federal	$ 0	$ 0	$ 0
State	409	76	211
Foreign	1,433	174	26
Total current income tax expense	1,842	250	237
Deferred:
Federal	0	0	(422)
State	0	0	(117)
Foreign	(4,498)	(2,868)	1,084
Total deferred income tax (benefit) expense	(4,498)	(2,868)	545
Income tax (benefit) expense	$ (2,656)	$ (2,618)	$ 782

Goodwill and Intangible Assets - Schedule of Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Balance at beginning of period	$ 94,414	$ 105,510
Foreign currency translation adjustment	5,003	(11,096)
Balance at end of period	$ 99,417	$ 94,414

- Definition

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

+ References + Details

Stockholders' Equity - Schedule of Fair Value Assumptions (Details)	12 Months Ended
	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock volatility (as a percent)	63.49%
Dividend rate (as a percent)	0.00%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)	5 years 5 months 15 days
Risk-free interest rate (as a percent)	0.53%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)	6 years
Risk-free interest rate (as a percent)	1.16%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Consolidated Statements of Stockholders' Equity (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Closing costs	$ 192	$ 11,272
Common Stock
Follow-on offering - issuance of shares, less offering costs (in shares)	2,012,500	4,025,000
Sale of stock, price per share (in USD per share)	$ 63.85	$ 50.00
Closing costs	$ 192	$ 11,272

Stockholders' Equity - Schedule of Stock-based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 44,536	$ 32,018	$ 25,164
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	9,362	6,734	5,980
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	11,687	7,965	8,079
Sales and marketing
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 23,487	$ 17,319	$ 11,105

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Acquisition (Tables)

12 Months Ended

Dec. 31, 2023

Business Combination and Asset Acquisition [Abstract]

Schedule of Allocation of Total Purchase Consideration

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
Operating 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

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

Schedule of Pro Forma Information

The following unaudited pro forma financial information presents the consolidated results of operations of the Company with Contura for the year ended December 31, 2021, 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 income (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 year ended December 31, 2021.




Net revenue	$	181,643
Net loss	$	(77,535)
Net loss per share, basic and diluted	$	(1.79)
Weighted-average shares used to compute basic and diluted net loss per share	43,237,536

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.

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

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash Flows from Operating Activities
Net loss	$ (6,088)	$ (59,698)	$ (80,067)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities
Depreciation and amortization	12,487	11,721	9,126
Loss on disposal of property and equipment	1	69	91
Stock-based compensation	44,536	32,018	25,164
Acquired in-process research & development	15,447	0	0
Amortization of debt issuance costs	0	0	4,991
(Reversal of) provision for allowance of credit losses	121	(34)	(122)
Change in fair value of contingent consideration	2,400	22,230	2,740
Deferred income taxes	(6,569)	(859)	460
Other items, net	1,755	675	122
Changes in operating assets and liabilities, net of business acquisition
Accounts receivable	(12,431)	(15,968)	(8,998)
Inventory	(25,753)	8,423	(1,108)
Prepaid expenses and other current assets	(10,403)	(862)	(940)
Other assets	(2,633)	(207)	(225)
Accounts payable	9,014	1,468	(2,862)
Accrued liabilities	3,887	1,032	(1,976)
Accrued compensation and benefits	(444)	3,112	6,155
Operating lease liabilities	27	71	143
Payment of contingent consideration	(27,370)	0	0
Net cash (used in) provided by operating activities	(2,016)	3,191	(47,306)
Cash Flows from Investing Activities
Purchases of property and equipment	(3,550)	(2,223)	(2,261)
Acquisition of a business, net of cash acquired	0	0	(140,741)
Purchases of short-term investments	(426,604)	(175,110)	0
Proceeds from sales and maturities of short-term investments	313,250	56,979	0
Net cash used in investing activities	(116,904)	(120,354)	(143,002)
Cash Flows from Financing Activities
Proceeds from exercise of stock options	4,250	5,662	6,757
Payment of contingent consideration	(7,630)	0	0
Payment of debt issuance costs	0	0	(106)
Proceeds from debt	0	0	75,000
Repayment of debt	0	0	(101,116)
Proceeds from offering of common stock upon follow-on public offering	0	128,498	201,250
Payment of common stock offering costs upon follow-on public offering	0	(192)	(11,272)
Net cash (used in) provided by financing activities	(3,380)	133,968	170,513
Effect of exchange rate changes on cash, cash equivalents and restricted cash	979	1,163	(508)
Net (decrease) increase in cash, cash equivalents and restricted cash	(121,321)	17,968	(20,303)
Cash and cash equivalents, beginning of year	104,811	238,846	220,878
Cash, cash equivalents and restricted cash, end of year	117,525	238,846	220,878
Supplemental Disclosure of Cash Flow Information
Cash paid for interest	69	1	2,178
Cash paid for taxes	255	667	1
Noncash Investing and Financing Activities
Property and equipment acquired but not yet paid	203	67	0
Property and equipment acquired from tenant improvement allowance	3,633	0	0
Common stock issuance for acquired in-process research & development	15,447	0	0
Common stock issuance for business acquisition	0	0	55,728
Contingent consideration for business acquisition	0	0	7,630
Common stock issuance for exclusive license asset	0	0	3,637
Accrued loan fees as debt issuance costs	$ 0	$ 0	$ 4,500

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts receivable, allowance for credit losses	$ 442	$ 321
Preferred stock, par value (in USD per share)	$ 0.0001	$ 0.0001
Preferred stock, authorized (in shares)	10,000,000	10,000,000
Preferred stock, issued (in shares)	0	0
Preferred stock, outstanding (in shares)	0	0
Common stock, par value (in USD per share)	$ 0.0001	$ 0.0001
Common stock, authorized (in shares)	75,000,000	75,000,000
Common stock, issued (in shares)	50,770,520	49,546,727
Common stock, outstanding (in shares)	50,770,520	49,546,727

Nature of Operations and Summary of Significant Accounting Policies - Schedule of Revenue Disaggregated by Geographic Market (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Disaggregation of Revenue [Line Items]
Net revenue	$ 366,379	$ 273,702	$ 180,290
SNM net revenue
Disaggregation of Revenue [Line Items]
Net revenue	291,805	221,991	157,590
Bulkamid net revenue
Disaggregation of Revenue [Line Items]
Net revenue	74,574	51,711	22,700
United States \| SNM net revenue
Disaggregation of Revenue [Line Items]
Net revenue	284,846	216,861	153,837
United States \| Bulkamid net revenue
Disaggregation of Revenue [Line Items]
Net revenue	59,036	40,178	12,660
International markets \| SNM net revenue
Disaggregation of Revenue [Line Items]
Net revenue	6,959	5,130	3,753
International markets \| Bulkamid net revenue
Disaggregation of Revenue [Line Items]
Net revenue	$ 15,538	$ 11,533	$ 10,040

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- 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

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-Topic 924
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-Name Accounting Standards Codification
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-Topic 280
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-Topic 280
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Nature of Operations and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

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. 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. 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 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 both rechargeable (R20) and recharge-free (F15) implantable sacral neuromodulation (SNM) systems, which deliver 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 Company’s products are protected by intellectual property based on Company-generated innovations and patents and other intellectual property licensed from AMF. The Company has regulatory marketing approvals in the United States for all relevant clinical indications. In Europe, Canada, and Australia, the Company has regulatory marketing approvals for most relevant clinical indications. The premarket approval (PMA) application for the Company’s first rechargeable 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 first rechargeable 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 first rechargeable SNM system in the fourth quarter of 2019.

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). Beginning in March 2022 with the FDA approval of the Company’s long-lived, recharge-free F15 SNM implantable stimulator, the Company now markets and sells the F15 recharge-free system to customers in the United States in addition to the rechargeable SNM system. The new recharge-free SNM system and Bulkamid are protected by intellectual property based on Company-generated innovations or patents acquired as part of the Contura acquisition. For more information, see Note 9.

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.

August 2022 Follow-On Offering

On August 5, 2022, the Company completed a follow-on offering by issuing 2,012,500 shares of common stock, at an offering price of $63.85 per share, inclusive of 262,500 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 $128.3 million, after deducting offering expenses payable by the Company.

Acquisition of in-process research & development (IPR&D) from Radian, LLC

In April 2023, the Company acquired the assets of Radian, LLC, for total consideration of the issuance of 264,783 shares of the Company’s common stock and a potential future milestone payment of up to $2.5 million (the Radian acquisition).

The Company evaluated this acquisition in accordance with Accounting Standards Codification (ASC) 805, Business Combinations, to determine whether the asset acquired met the definition of a business. Included in the IPR&D is the historical know-how, software, formula protocols, designs, and procedures expected to be needed to complete the technology asset and receive regulatory approval. The Company concluded that the IPR&D is an identifiable intangible asset that would be accounted for as a single asset in a business combination. The Company

also qualitatively concluded that there is no fair value associated with any other assets included in the acquisition. Therefore, all of the consideration in the transaction was allocated to the IPR&D. As such, the Company concluded that substantially all of the fair value of the gross assets acquired was concentrated in the single IPR&D asset and the asset was not a business.

The Company is planning to use the acquired IPR&D technology to provide a solution to make peripheral nerve evaluation lead placement easier, faster, and more accurate. Although the acquired technology may have utility in other medical procedures, future development decisions for the acquired technology will be contingent upon the receipt of required regulatory approvals. As such, the acquired technology does not have an alternative future use at the acquisition date. In accordance with ASC 730, Research and Development, the Company concluded the entire purchase price for the asset acquisition was an expense on the acquisition date.

The consideration transferred at closing had an acquisition date fair value of $15.4 million based on a per share value of $58.34 on the acquisition date and was recognized immediately as IPR&D expense in the unaudited condensed consolidated statements of comprehensive income (loss) for the year ended December 31, 2023. The potential future milestone payment of $2.5 million, payable in either cash or shares of the Company’s common stock, will become payable if the Company receives the FDA 510(k) clearance for the acquired IPR&D technology.

Principles of Consolidation

The accompanying consolidated financial statements include the accounts of the Company and 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 2023 presentation.

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 disclosures 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. Such estimates and assumptions include the useful lives of property and equipment and intangible assets, the valuation of deferred income tax assets and liabilities, the valuation of contingent consideration liability, the valuation of stock-based compensation, the product returns reserve, the inventory obsolescence reserve and accounts receivable allowance for credit losses.

Revenue Recognition

Revenue recognized during the years ended December 31, 2023, 2022, and 2021 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 expected to be received 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. 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 $0.3 million and $0.2 million at December 31, 2023 and 2022, respectively, and is recorded as a reduction of gross revenue in its consolidated statements of comprehensive income (loss). Damaged or defective products are replaced at no charge under the Company’s standard warranty. For the years ended December 31, 2023, 2022, and 2021, the replacement costs were $0.1 million, $0.2 million, and $0.2 million, respectively. The replacement costs are recorded within the sales and marketing expenses in its consolidated statements of comprehensive income (loss).

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 liability at the time of revenue recognition and records it as a charge to sales and marketing expense. The warranty liability as of December 31, 2023 and 2022 was $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, 2023, 2022, and 2021 (in thousands):


	Years Ended December 31,
	2023		2022		2021
SNM net revenue
United States	$	284,846	$	216,861	$	153,837
International markets	6,959		5,130		3,753
	$	291,805	$	221,991	$	157,590
Bulkamid net revenue(1)
United States	$	59,036	$	40,178	$	12,660
International markets	15,538		11,533		10,040
	$	74,574	$	51,711	$	22,700
Total net revenue	$	366,379	$	273,702	$	180,290

_____________________________________________

(1) The acquisition of Bulkamid was completed on February 25, 2021. Reported revenue includes sales from February 26, 2021 onwards.

Allowance for Credit Losses

The Company makes estimates of the collectability of accounts receivable in accordance with Accounting Standards Update (ASU) 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The Company’s estimate of future credit 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 change in such a manner as to negatively impact their cash flows. 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,
	2023		2022		2021
Balance at beginning of period	$	321	$	355	$	465
Write-offs	(15)		(75)		(12)
Bad debt expense (recoveries)	136		41		(98)
Balance at end of period	$	442	$	321	$	355

Cash and Cash Equivalents

Cash equivalents consist of short-term, highly liquid investments purchased with a 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. The Company also holds cash in foreign banks that are not federally insured. The Company has not experienced any losses on its deposits of cash and cash equivalents.

Restricted Cash

Restricted cash consists of amounts held by an escrow account. On September 18, 2023, the Company commenced an arbitration against AMF with Judicial Administration and Arbitration Services (JAMS) seeking, among other things, resolution that AMF’s purported attempt to terminate the License Agreement, dated October 1, 2013, was ineffective and that the Company does not owe any royalties to AMF for the Company’s F15 product and that the Company was not required to pay royalties on its F15 product under the License Agreement. AMF responded to the arbitration demand and asserted multiple claims. On October 5, 2023, the Company and AMF entered into an interim agreement while the arbitration proceedings were pending. Pursuant to this interim agreement, the Company agreed to deposit into an escrow account an amount equal to 4% of the net revenues previously received for sales of the Company’s F15 product that are the subject of dispute. As of December 31, 2023, the Company has deposited approximately $12.7 million in the escrow account, and will continue to deposit the disputed 4% of net revenues of the Company’s F15 product with interest into the escrow account during the pendency of the arbitration proceedings. The Company has paid and, under this interim agreement, will continue to pay 4% royalties on rechargeable products. While the Company believes that AMF’s claims are without merit and intends to vigorously defend against those claims, there can be no assurance as to the outcome of the arbitration. For additional information, see Note 4.

The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheet to the amounts reported within the consolidated statement of cash flows at December 31, 2023:




Cash and cash equivalents	$	104,811
Restricted cash	12,714
Total cash, cash equivalents, and restricted cash shown in the consolidated statement of cash flows	$	117,525

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.

Level 1 investments include U.S. government and agency securities, which are valued based on prices readily available in the active markets in which those securities are traded. Level 2 investments include commercial paper and corporate notes, which is valued on a recurring basis based on inputs that are readily available in public markets or can be derived from information available in publicly quoted markets.

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, and accounts payable, due to their short-term nature.

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.

The Company’s business combination of Contura involved potential payment of future consideration that was contingent upon the achievement of certain product development milestones and/or contingent on the acquired business reaching certain performance milestones. A liability was recorded for the estimated fair value of the contingent consideration on the acquisition date. The fair value of the contingent consideration was remeasured at each reporting period, and the change in fair value was recognized within operating expenses in the consolidated statements of comprehensive income (loss).

On February 25, 2021, the Company acquired Contura Limited and its Bulkamid product, a urethral bulking agent indicated for the treatment of female SUI. In consideration for the acquisition, the Company paid approximately $141.3 million in cash and issued 1,096,583 shares of our common stock. The agreement also provided that the Company may pay an additional $35 million in the event Bulkamid sales in any consecutive 12-month period exceed $50 million (the Milestone) before December 31, 2024, with payment due within 50 business days following the quarter in which the Milestone has been met.

At March 31, 2023, the Milestone was met and payment was made during the year ended December 31, 2023. The fair value of contingent consideration of $32.6 million is reflected in other current liabilities in the Company’s consolidated balance sheet at December 31, 2022.

The following table summarizes the changes in the fair value of recurring Level 3 fair value measurements during the years ended December 31, 2023 and 2022 (in thousands):




Liabilities
Contingent consideration:
December 31, 2021	$	10,370

Change in fair value included in net loss	22,230
December 31, 2022	32,600
Change in fair value included in net loss	2,400
Payment made	$	(35,000)
December 31, 2023	$	—

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

Investment Securities

The Company classifies its investment securities as available-for-sale. Those investments in debt securities with maturities less than 12 months at the balance sheet date are considered short-term investments. Those investments in debt securities with maturities greater than 12 months at the balance sheet date 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 (loss) within the consolidated statements of comprehensive income (loss). There were no unrealized gains or losses during the years ended December 31, 2023, 2022, and 2021.

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 credit loss allowance 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, accretion and interest income are recognized when earned. Realized gains or losses are included in net loss and are derived using the specific identification method for determining the cost of securities sold.

The following table presents the fair value hierarchy for those assets measured at fair value on a recurring basis as of December 31, 2023 and 2022 (in thousands):


	Fair Value Measurements at December 31, 2023
Assets(1):	Level 1		Level 2		Level 3		Total
Commercial paper	$	—	$	179,881	$	—	$	179,881
Corporate notes	—		18,279		—		18,279
U.S. government and agency securities	91,703		—		—		91,703
	$	91,703	$	198,160	$	—	$	289,863

_____________________________________________

(1) As of December 31, 2023, commercial paper investments of $49.7 million are included in cash and cash equivalents on the consolidated balance sheets, as the investments had a maturity of three months or less from the date of purchase.


	Fair Value Measurements at December 31, 2022
Assets(1):	Level 1		Level 2		Level 3		Total
Commercial paper	$	—	$	175,548	$	—	$	175,548
Corporate notes	—		4,675		—		4,675
U.S. government and agency securities	75,212		—		—		75,212
	$	75,212	$	180,223	$	—	$	255,435

_____________________________________________

(1) As of December 31, 2022, commercial paper investments of $131.1 million, U.S. government and agency securities of $4.0 million, and corporate notes of $2.0 million are included in cash and cash equivalents on the consolidated balance sheets, as the investments had a maturity of three months or less from the date of purchase.

The Company holds investments in marketable debt securities that are classified and accounted for as cash equivalents or available-for-sale and are remeasured on a recurring basis. All of the Company’s available-for-sale debt securities are classified on the consolidated balance sheet as cash equivalents or short-term investments. The following table summarizes the Company’s cash equivalents and investments in available-for-sale debt securities by significant investment category as of December 31, 2023 and 2022 (in thousands):


	December 31, 2023
	Cost		Unrealized gains		Unrealized losses		Fair value
Cash equivalents:
Commercial paper	$	49,714	$	—	$	—	$	49,714
Corporate notes	—		—		—		—
U.S. government and agency securities	—		—		—		—
Total cash equivalents	$	49,714	$	—	$	—	$	49,714
Short-term investments:
Commercial paper	$	130,161	$	9	$	(3)	$	130,167
Corporate notes	18,272		18		(11)		18,279
U.S. government and agency securities	91,670		40		(7)		91,703
Total short-term investments	$	240,103	$	67	$	(21)	$	240,149

Total	$	289,817	$	67	$	(21)	$	289,863


	December 31, 2022
	Cost		Unrealized gains		Unrealized losses		Fair value
Cash equivalents:
Commercial paper	$	131,075	$	—	$	—	$	131,075
Corporate notes	2,013		—		—		2,013
U.S. government and agency securities	3,982		—		—		3,982
Total cash equivalents	$	137,070	$	—	$	—	$	137,070
Short-term investments:
Commercial paper	$	44,473	$	—	$	—	$	44,473
Corporate notes	2,664		—		(2)		2,662
U.S. government and agency securities	71,342		6		(118)		71,230
Total short-term investments	$	118,479	$	6	$	(120)	$	118,365

Total	$	255,549	$	6	$	(120)	$	255,435

Inventory, Net

Inventory is 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 inventory 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 expenses 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 ASC 730, Research and Development. Component materials and purchased products associated with clinical development programs are included in inventory and charged to research and development expenses 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 expenses 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 Company’s SNM systems 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, 2023, the Company had $48.9 million, $10.5 million and $20.5 million of finished goods inventory, work-in-process inventory and raw materials inventory, respectively, net of reserves of $2.3 million. As of December 31, 2022, the Company had $30.4 million, $5.7 million and $19.7 million of finished goods inventory, work-in-process inventory and raw materials inventory, respectively, net of reserves of $0.5 million.

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, 2023 and 2022, all foreign currency translation gains (losses) have been unrealized and included in accumulated other comprehensive income (loss). Accumulated other comprehensive income (loss) consists entirely of losses or gains from translation of foreign subsidiaries at December 31, 2023 and 2022.

Customer and Vendor Concentration

As of December 31, 2023 and 2022, there were no customers who accounted for over 10% of the Company’s consolidated accounts receivable. As of December 31, 2023 and 2022, there were three vendors and one vendor, respectively, who accounted for over 10% of the Company’s consolidated accounts payable. As of December 31, 2023, 2022, and 2021, there were no customers who accounted for over 10% of the Company’s consolidated net revenue. As of December 31, 2023, 2022, and 2021, there were three, three, 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 both tangible and intangible 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 value of its reporting unit using a combination of the discounted cash flow 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. There has been no goodwill impairment charges during the years ended December 31, 2023, 2022, and 2021.

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 initial public offering, 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 was 8.71 years. The asset has been fully amortized as of December 31, 2022.

Exclusive license asset

The intangible asset represents exclusive rights to existing technologies and development services from Micro Systems Engineering, Inc. pursuant to an agreement entered into on March 2, 2021. The rights and services were provided in exchange for 65,594 shares of common stock, 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 has been no intangible asset impairment charges during the years ended December 31, 2023, 2022, and 2021.

Contura acquisition

The intangible assets represent technology, trade names and trademarks, and customer relationships acquired from Contura on February 25, 2021. The trade names and trademarks have an indefinite life. The straight-line method over the period of estimated benefit is used to amortize technology. ASC 350-30-35-3, General Intangibles other than Goodwill, 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. The Company will review the intangible assets for impairment whenever an impairment indicator exists. There have been no intangible asset impairment charges during the year ended December 31, 2023. During the year ended December 31, 2022, as Bulkamid SARL

ceased sales operations and did not recognize revenue and does not expect to recognize revenue in future periods, the Company wrote off the customer relationships intangible asset of $0.3 million related to this entity. The impairment expense was recorded within the general and administrative expenses in its consolidated statements of comprehensive income (loss).

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 has been no intangible asset impairment charges during the years ended December 31, 2023 and 2021. There has been $0.3 million of intangible asset impairment charges during the year ended December 31, 2022.

Indefinite-lived intangible assets are tested for impairment annually in the fourth quarter of the fiscal year and whenever events or changes in circumstances indicate that the carrying amount may be impaired. Impairment is calculated as the excess of the asset’s carrying value over its fair value. Fair value is generally determined using a discounted future cash flow analysis. There have been no impairments to indefinite-lived intangible assets during the years ended December 31, 2023, 2022 and 2021.

Leases

In accordance with ASU 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.

Operating lease right-of-use (ROU) assets 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 in similar economic environment, based on the information available at commencement date in determining the present value of future payments. The operating lease ROU assets also include any lease payments made and excludes lease incentives and initial direct costs incurred, and are included in other assets in the Company’s consolidated balance sheets. 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 employee compensation, including stock-based compensation, product development, including testing and engineering, royalty expense, and clinical studies to develop and support the Company’s products, including clinical study and registry management and monitoring, payments to clinical investigators, and data management. Other research and development expenses include consulting and advisory fees, royalty expense, travel expenses, and equipment-related expenses and other miscellaneous office and facilities expenses related to research and development programs.

Advertising Expense

The Company expenses advertising costs as they are incurred. During the years ended December 31, 2023, 2022, and 2021, advertising expense totaled $19.5 million, $20.6 million and $7.8 million, respectively, and are recorded within the sales and marketing expenses in its consolidated statements of comprehensive income (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 and a partial valuation allowance on certain foreign 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 three or 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 three or 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 is 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. If such targets are not met or service is not rendered for the requisite service period, no compensation cost is recognized, and any recognized compensation cost in prior periods will be reversed. In addition, the Company also grants market-based RSUs 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). Compensation cost is not adjusted if the market condition is not met, as long as the requisite service is provided.

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, 2023, 2022, and 2021, there were 2,132,330, 2,328,525, and 2,444,444 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% of its products to customers in the United States. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance.

Recent Accounting Pronouncements

In December 2023, the Financial Accounting Standards Board (FASB) issued ASU 2023-09, Improvements to Income Tax Disclosures (ASU 2023-09). The guidance is intended to improve income tax disclosure requirements by requiring (i) consistent categories and greater disaggregation of information in the rate reconciliation and (ii) the disaggregation of income taxes paid by jurisdiction. The guidance makes several other changes to the income tax disclosure requirements. This guidance is effective for annual periods beginning after December 15, 2024, with early adoption permitted, and is required to be applied prospectively with the option of retrospective application. The Company is evaluating the impact of the standard on its financial statements and related disclosures.

In November 2023, the FASB issued ASU 2023-07 to require the disclosure of segment expenses if they are (i) significant to the segment, (ii) regularly provided to the CODM, and (iii) included in each reported measure of a segment’s profit or loss. Public entities will be required to provide this disclosure quarterly. In addition, this ASU requires an annual disclosure of the CODM’s title and a description of how the CODM uses the segment’s profit/loss measure to assess segment performance and to allocate resources. This guidance is effective for annual periods beginning after December 15, 2023 and interim periods beginning after December 15, 2024, with early adoption permitted, and is required to be applied retrospectively to all prior periods presented in the financial statements. The Company is evaluating the impact of the standard on its financial statements and related disclosures.

Acquisition - Schedule of Preliminary Allocation of Total Purchase Consideration (Details) - USD ($) $ in Thousands	Feb. 25, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Liabilities Assumed
Goodwill		$ 99,417	$ 94,414	$ 105,510
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
Total assets acquired	115,744
Liabilities Assumed
Accounts payable	209
Accrued liabilities	820
Accrued compensation and benefits	315
Operating lease liability	86
Debt	122
Deferred tax liabilities	19,286			$ 19,300
Total liabilities assumed	20,838
Net assets acquired	94,906
Purchase price consideration	204,692
Goodwill	$ 109,786

Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Income Taxes

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


	Years Ended December 31,
	2023		2022		2021
Domestic	$	1,916	$	(24,466)	$	(56,105)
Foreign	(10,660)		(37,850)		(23,180)
Total	$	(8,744)	$	(62,316)	$	(79,285)

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


	Years Ended December 31,
	2023		2022		2021
Current:
Federal	$	—	$	—	$	—
State	409		76		211
Foreign	1,433		174		26
Total current income tax expense	$	1,842	$	250	$	237
Deferred:
Federal	$	—	$	—	$	(422)
State	—		—		(117)
Foreign	(4,498)		(2,868)		1,084
Total deferred income tax (benefit) expense	$	(4,498)	$	(2,868)	$	545
Total	$	(2,656)	$	(2,618)	$	782

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


	Years Ended December 31,
	2023		2022		2021
Tax at statutory federal rate	21.0	%	21.0	%	21.0	%
State tax, net of federal benefit	(0.5)	%	1.0	%	3.8	%
Excess tax benefits related to stock-based compensation	46.6	%	8.3	%	9.4	%
Non-deductible stock-based compensation	(75.1)	%	(1.7)	%	(1.4)	%
Tax rate change	9.2	%	1.0	%	(5.2)	%
Net operating loss adjustments	—	%	—	%	(7.9)	%

R&D tax credit, net of reserve	40.3	%	4.1	%	6.1	%
Change in valuation allowance	(0.9)	%	(19.6)	%	(24.5)	%
Change in fair value of contingent consideration	(6.4)	%	(7.3)	%	—	%
Other deferred adjustments	1.9	%	(0.8)	%	0.4	%
Other permanent differences	(9.7)	%	—	%	—	%
Other	4.0	%	(1.8)	%	(2.7)	%
Effective tax rate	30.4	%	4.2	%	(1.0)	%

Our effective tax rate was 30.4% for the year ended December 31, 2023, compared to an effective tax rate of 4.2% for the year ended December 31, 2022 and (1.0)% for the year ended December 31, 2021. 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, change in fair value of the contingent consideration, change in valuation allowance and other deferred adjustments. The difference in the effective tax rate of 30.4% for the year ended December 31, 2023 as compared to the effective tax rate of 4.2% for the year ended December 31, 2022 was primarily due to Section 162(m) deduction limitations on certain executive compensation, increase in R&D tax credit, and change in valuation allowance during the year ended December 31, 2023.

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,
	2023		2022
Deferred Tax Assets:
Stock-based compensation	$	4,761	$	4,855
Depreciation and amortization	120		(196)
Operating lease liabilities	6,454		2,169
Net operating loss carryforwards	62,680		76,013
Research and development credit carryforwards	22,690		7,332
Interest expense limitation carryforwards	9,107		5,457
Other	3,904		10,209
Total deferred tax assets	109,716		105,839
Less: valuation allowance	(96,880)		(96,751)
Total net deferred tax assets	$	12,836	$	9,088

Deferred Tax Liabilities:
ROU assets	$	(7,289)	$	(1,464)
Intangible assets	(16,250)		(24,036)
Total deferred tax liabilities	$	(23,539)	$	(25,500)

Net deferred tax liabilities	$	(10,703)	$	(16,412)

At December 31, 2023, the Company had U.S. federal net operating loss (NOL) carryforwards of approximately $218.6 million. Approximately $2.2 million of U.S. federal NOLs will expire in 2037 and remaining U.S. federal NOLs will carryover indefinitely. The Company had U.S. state NOLs of $245.5 million, which will expire between 2033 and 2042. The foreign net operating loss carryforwards have an indefinite carryforward period.

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 and a partial valuation allowance on certain foreign deferred tax assets as of December 31, 2023 and 2022. The Company considered all positive and negative historical and prospective evidence in determining its valuation allowance position. The valuation allowance increased by $0.1 million for the year ended December 31, 2023, from $96.8 million to $96.9 million. This increase in the valuation allowance during

the year ended December 31, 2023, was largely attributable to the Radian acquisition and Section 174 capitalization. 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 studies performed in 2023, 2022 and 2021, the Company determined that an ownership change did not occur in 2023, 2022 and 2021. Future ownership changes could impact the Company’s ability to utilize NOL carryforwards.

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, 2023 and 2022. 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, 2021	$	3,404
Additions based on tax positions related to the current year	574

Deductions for tax positions taken due to settlement	(1,603)
Balance at December 31, 2022	2,375
Additions based on tax positions related to the current year	852
Additions based on tax positions related to the prior year	339
Deductions for tax positions taken due to settlement	(83)

Balance at December 31, 2023	$	3,483

As of December 31, 2023, the total unrecognized tax benefits was $3.5 million. The total amount of unrecognized tax benefit that would affect the effective tax rate was approximately $0.1 million. Due to the time lapse of the indirect ownership change in 2016 whereby losses were utilized in 2017 and 2018, there was a release of uncertain tax positions. There was no interest or penalties to be recognized for the tax year ended December 31, 2023.

The Company has net operating loss and research and development credit carryforwards which may be subject to examination by taxing authorities for tax years beginning with the year ended December 31, 2019. As of December 31, 2023, tax years beginning with the years ended December 31, 2016, December 31, 2017 and December 31, 2018 are no longer 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-17

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Nature of Operations and Summary of Significant Accounting Policies - Schedule of Changes in Allowance for Doubtful Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 321	$ 355	$ 465
Write-offs	(15)	(75)	(12)
Bad debt expense (recoveries)	136	41	(98)
Balance at end of period	$ 442	$ 321	$ 355

Property and Equipment, Net - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property and Equipment
Property, Plant and Equipment [Line Items]
Depreciation expense	$ 3.4	$ 2.3	$ 1.9

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2023
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On January 8, 2024, the Company entered into an Agreement and Plan of Merger (the Merger Agreement) with Boston Scientific Corporation, a Delaware corporation (Boston Scientific), and Sadie Merger Sub, Inc., a Delaware corporation and wholly owned subsidiary of Boston Scientific (Merger Sub), providing for the merger of Merger Sub with and into the Company (the Merger), with the Company surviving the Merger as a wholly owned subsidiary of Boston Scientific. The consummation of the Merger is subject to certain closing conditions, including, among others, the approval of the Company’s stockholders of the adoption of the Merger Agreement, the expiration or termination of any waiting periods (and any extension thereof) applicable to the consummation of the Merger under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, and any agreement with a governmental authority not to consummate the Merger, and receipt of certain additional consents, approvals, non-disapprovals and other authorizations of certain other governmental bodies applicable to the Merger. If the Merger is consummated, at the effective time of the Merger (the Effective Time), each share of common stock, par value $0.0001 per share, of the Company issued and outstanding immediately prior to the Effective Time (each, a Share and collectively, the Shares), other than Shares (i) held in the treasury of the Company or owned by any direct or indirect wholly owned subsidiary of the Company, (ii) owned by Merger Sub, Boston Scientific or any direct or indirect wholly owned subsidiary of Boston Scientific or (iii) held by holders who are entitled to and have properly exercised and not waived, withdrawn, failed to perfect or otherwise lost their appraisal rights., will be automatically canceled and converted into the right to receive $71.00 in cash, without interest.

Nature of Operations and Summary of Significant Accounting Policies - Narrative (Details)					1 Months Ended	12 Months Ended				24 Months Ended
	Aug. 05, 2022 USD ($) $ / shares shares	May 14, 2021 USD ($) $ / shares shares	Mar. 02, 2021 USD ($) shares	Feb. 25, 2021 USD ($) shares	Apr. 30, 2023 USD ($) $ / shares shares	Dec. 31, 2023 USD ($) segment shares	Dec. 31, 2022 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) $ / shares shares	Dec. 31, 2013 USD ($) shares	Dec. 31, 2023 USD ($)	Oct. 05, 2023	Jun. 30, 2021 USD ($)
Revenue Recognition:
Allowance for product returns						$ 300,000	$ 200,000			$ 300,000
Replacement costs						100,000	200,000	$ 200,000
Warranty liability						100,000	100,000			100,000
Investment Securities:
Unrealized gain (loss) on investment securities						0	0	0
Inventory:
Finished goods inventory						48,900,000	30,400,000			48,900,000
Work-in-process inventory						10,500,000	5,700,000			10,500,000
Raw materials inventory						20,500,000	19,700,000			20,500,000
Inventory reserves						2,300,000	500,000			$ 2,300,000
Goodwill:
Impairment charges related to goodwill						$ 0	$ 0	0
Intangible Asset:
Fair value of shares issued for purchase of intangible asset								3,637,000
Impairment of intangible asset [Extensible Enumeration]						General and administrative	General and administrative
Impairment of Long-Lived Assets:
Impairment of long-lived assets						$ 0	$ 300,000	0
Impairment of long-lived assets [Extensible Enumeration]						General and administrative
Impairment of indefinite-lived intangible assets						$ 0	0	0
Advertising Expense:
Advertising expense						$ 19,500,000	$ 20,600,000	$ 7,800,000
Net Loss per Share of Common Stock:
Potentially dilutive weighted-average shares not included in computation of diluted weighted-average shares (in shares) \| shares						2,132,330	2,328,525	2,444,444
Segment Reporting
Number of operating segments \| segment						1
Radian, LLC
Acquisition of in-process research & development (IPR&D) from Radian, LLC
Consideration amount, equity interest issued and issuable (in shares) \| shares					264,783
Consideration amount, contingent consideration					$ 2,500,000
Common stock issuance for acquired in-process research & development					$ 15,400,000
Consideration amount, per share (in USD per share) \| $ / shares					$ 58.34
Revenue Benchmark \| Geographic Concentration Risk \| United States
Segment Reporting
Concentration risk (as a percent)						90.00%
Restricted Stock Units
Stock-Based Compensation:
Vesting period (in years)						1 year
Patent license asset
Intangible Asset:
Finite-lived intangible asset acquired									$ 1,000,000
Finite-lived intangible assets, weighted-average amortization period (in years)						8 years 8 months 15 days
Exclusive license asset
Intangible Asset:
Finite-lived intangible asset acquired			$ 3,300,000
Finite-lived intangible assets, weighted-average amortization period (in years)						4 years
Vendor credit in accounts payable			$ 300,000
Impairment of intangible asset						$ 0	$ 0	$ 0
Preferred Stock \| Patent license asset
Intangible Asset:
Stock issued for purchase of intangible asset (in shares) \| shares									50,000
Fair value of shares issued for purchase of intangible asset									$ 1,000,000
Common Stock
Follow-On Offering:
Sale of stock, stock price (in USD per share) \| $ / shares							$ 63.85	$ 50.00
Intangible Asset:
Stock issued for purchase of intangible asset (in shares) \| shares								65,594
Common Stock \| Exclusive license asset
Intangible Asset:
Stock issued for purchase of intangible asset (in shares) \| shares			65,594
Fair value of shares issued for purchase of intangible asset			$ 3,600,000
Minimum
Inventory:
Inventory shelf life (in months)						12 months
Property and Equipment:
Property and equipment useful life (in years)						3 years				3 years
Stock-Based Compensation:
Requisite service period of recognition of compensation cost (in years)						3 years
Minimum \| Stock Option and Restricted Stock-Based Awards
Stock-Based Compensation:
Vesting period (in years)						3 years
Maximum
Inventory:
Inventory shelf life (in months)						36 months
Property and Equipment:
Property and equipment useful life (in years)						7 years				7 years
Stock-Based Compensation:
Requisite service period of recognition of compensation cost (in years)						4 years
Maximum \| Stock Option and Restricted Stock-Based Awards
Stock-Based Compensation:
Vesting period (in years)						4 years
Contura
Fair Value of Financial Instruments:
Cash consideration transferred				$ 141,300,000
Stock transferred in acquisition (in shares) \| shares				1,096,583
Maximum contingent consideration				$ 35,000,000
Contingent consideration, term (in months)				12 months
Amount of sales to achieve for maximum contingent consideration				$ 50,000,000
Contingent consideration, milestone met payment term after quarter (in days)				50 days
Contingent consideration at fair value				$ 7,600,000
Contura \| Customer relationships
Intangible Asset:
Finite-lived intangible assets, weighted-average amortization period (in years)				12 years
Impairment of intangible asset						$ 0	$ 300,000
Contura \| Contingent Consideration Liability
Fair Value of Financial Instruments:
Contingent consideration at fair value				$ 6,800,000			$ 32,600,000					$ 7,600,000
F15
Restricted Cash:
Net revenue previously received for sales subject to dispute (as a percent)											4.00%
Net revenue subject of dispute with interest amount, held in escrow						$ 12,700,000				$ 16,000,000
Royalty payment (as a percent)						4.00%				4.00%
Follow-on Offering
Follow-On Offering:
Stock issued (in shares) \| shares	2,012,500	4,025,000
Sale of stock, stock price (in USD per share) \| $ / shares	$ 63.85	$ 50.00
Net proceeds from sale of stock	$ 128,300,000	$ 190,000,000
Exercise of Underwriters Option
Follow-On Offering:
Stock issued (in shares) \| shares	262,500	525,000

Subsequent Events (Details) - $ / shares	Jan. 08, 2024	Dec. 31, 2023	Dec. 31, 2022
Subsequent Event [Line Items]
Common stock, par value (in USD per share)		$ 0.0001	$ 0.0001
Subsequent Event \| Boston Scientific Corporation
Subsequent Event [Line Items]
Common stock, par value (in USD per share)	$ 0.0001
Business acquisition, equity conversion to cash, per share (in USD per share)	$ 71.00

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2023

Commitments and Contingencies Disclosure [Abstract]

Schedule of Total Lease Cost

Total lease costs for the years ended December 31, 2023, 2022, and 2021 are as follows (in thousands):


	December 31,
	2023		2022		2021
Lease cost
Operating lease cost	$	2,785	$	2,131	$	2,107
Short-term lease cost	85		80		95
Variable lease cost	527		203		191
Amortization of net lease liabilities	(1,667)		—		—
Total lease cost	$	1,730	$	2,414	$	2,393

Schedule of Payments of Operating Lease Liabilities

Payments of operating lease liabilities as of December 31, 2023, are as follows (in thousands):


2024	$	2,296
2025	4,388
2026	4,011
2027	4,151
2028	4,291
Thereafter	25,130
	44,267
Less: imputed interest	(16,650)
	27,617
Less: operating lease liabilities, current portion	(1,777)
Operating lease liabilities, net of current portion	$	25,840

Employee Benefit Plan	12 Months Ended
Employee Benefit Plan	Dec. 31, 2023
Retirement Benefits [Abstract]
Employee Benefit Plan	Employee Benefit Plan The Company sponsors a defined contribution retirement savings plan under Section 401(k) of the Internal Revenue Code. This plan covers all U.S. 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, 2023, 2022, and 2021, the Company contributions to the plan amounted to $2.8 million, $2.1 million, and $1.9 million, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 70
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480794/715-70-50-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 17
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480482/715-20-55-17

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(iv)(03)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (q)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (l)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//715/tableOfContent

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(iii)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (o)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (r)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480126/715-20-S99-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 60
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480266/715-60-50-3

+ Details

Commitments and Contingencies - Schedule of Total Lease Cost (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Operating lease cost	$ 2,785	$ 2,131	$ 2,107
Short-term lease cost	85	80	95
Variable lease cost	527	203	191
Amortization of net lease liabilities	(1,667)	0	0
Total lease cost	$ 1,730	$ 2,414	$ 2,393

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 (in shares) at Dec. 31, 2020		39,931,030
Balance at beginning 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 (in 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 (in 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 of shares, less offering costs (in shares)		4,025,000
Follow-on offering - issuance of shares, less closing costs	189,978	$ 1	189,977
Issuance of common stock for acquisition (in shares)		1,096,583
Issuance of common stock for acquisition	55,728		55,728
Issuance of common stock for exclusive license asset (in shares)		65,594
Issuance of common stock for exclusive license asset	3,637		3,637
Issuance of common stock for acquisition of in-process research & development	0
Foreign currency translation adjustment	(6,129)				(6,129)
Net loss	(80,067)			(80,067)
Balance at end of period (in shares) at Dec. 31, 2021		46,330,167
Balance at end of period at Dec. 31, 2021	482,438	$ 5	803,559	(314,566)	(6,560)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for employee stock option exercises for cash (in shares)		364,352
Issuance of common stock for employee stock option exercises for cash	5,662		5,662
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation (in shares)		570,778
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation	26,218		26,218
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation (in shares)		268,930
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation	5,800		5,800
Follow-on offering - issuance of shares, less offering costs (in shares)		2,012,500
Follow-on offering - issuance of shares, less closing costs	128,306		128,306
Issuance of common stock for acquisition	0
Issuance of common stock for acquisition of in-process research & development	0
Foreign currency translation adjustment	(18,587)				(18,587)
Net loss	$ (59,698)			(59,698)
Balance at end of period (in shares) at Dec. 31, 2022	49,546,727	49,546,727
Balance at end of period at Dec. 31, 2022	$ 570,139	$ 5	969,545	(374,264)	(25,147)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for employee stock option exercises for cash (in shares)		219,763
Issuance of common stock for employee stock option exercises for cash	4,250		4,250
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation (in shares)		523,279
Restricted Shares Award (RSA) issuances and forfeitures for terminations, net and stock-based compensation	31,750		31,750
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation (in shares)		215,968
Issuance of common stock for vesting of Restricted Stock Units (RSU) and stock-based compensation	12,786		12,786
Issuance of common stock for acquisition	0
Issuance of common stock for acquisition of in-process research & development (in shares)		264,783
Issuance of common stock for acquisition of in-process research & development	15,447		15,447
Foreign currency translation adjustment	9,280				9,280
Net loss	$ (6,088)			(6,088)
Balance at end of period (in shares) at Dec. 31, 2023	50,770,520	50,770,520
Balance at end of period at Dec. 31, 2023	$ 637,564	$ 5	$ 1,033,778	$ (380,352)	$ (15,867)

Consolidated Statements of Comprehensive Income (Loss) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Net revenue	$ 366,379	$ 273,702	$ 180,290
Cost of goods sold	91,825	76,037	64,572
Gross profit	274,554	197,665	115,718
Operating expenses
Research and development	34,886	34,410	37,297
General and administrative	45,754	40,238	30,041
Sales and marketing	189,562	156,019	105,789
Amortization of intangible assets	9,064	9,383	7,241
Acquisition-related costs	5,898	22,561	7,158
Acquired in-process research & development	15,447	0	0
Total operating expenses	300,611	262,611	187,526
Loss from operations	(26,057)	(64,946)	(71,808)
Other income (expense)
Interest and other income	16,690	5,133	40
Loss on disposal of property and equipment	(1)	(69)	(91)
Interest and other income (expense)	624	(2,434)	(7,426)
Other income (expense), net	17,313	2,630	(7,477)
Loss before income tax (benefit) expense	(8,744)	(62,316)	(79,285)
Income tax (benefit) expense	(2,656)	(2,618)	782
Net loss	(6,088)	(59,698)	(80,067)
Foreign currency translation adjustment	9,280	(18,587)	(6,129)
Comprehensive income (loss)	$ 3,192	$ (78,285)	$ (86,196)
Net loss per share, basic (in USD per share)	$ (0.12)	$ (1.28)	$ (1.86)
Net loss per share, diluted (in USD per share)	$ (0.12)	$ (1.28)	$ (1.86)
Weighted-average shares used to compute basic net loss per share (in shares)	49,081,470	46,684,478	43,072,298
Weighted-average shares used to compute diluted net loss per share (in shares)	49,081,470	46,684,478	43,072,298

Stockholders' Equity - Restricted Stock Units Narrative (Details) - Restricted Stock Units $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 3.7
Weighted-average period of recognition of compensation cost (in years)	10 months 24 days

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets
Cash and cash equivalents	$ 104,811	$ 238,846
Short-term investments	240,149	118,365
Accounts receivable, net of allowance for credit losses of $442 and $321 at December 31, 2023 and 2022, respectively	57,243	44,817
Inventory, net	79,940	55,765
Prepaid expenses and other current assets	9,279	7,282
Total current assets	491,422	465,075
Restricted cash	12,714	0
Property and equipment, net	10,760	6,798
Intangible assets, net	81,375	86,253
Other assets	24,235	6,813
Goodwill	99,417	94,414
Total assets	719,923	659,353
Current liabilities
Accounts payable	18,452	9,070
Accrued liabilities	10,527	6,520
Accrued compensation and benefits	15,060	15,495
Operating lease liabilities, current portion	1,777	1,562
Other current liabilities	0	32,600
Total current liabilities	45,816	65,247
Operating lease liabilities, net of current portion	25,840	7,555
Deferred tax liabilities, net	10,703	16,412
Total liabilities	82,359	89,214
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, 2023 and 2022	0	0
Common stock, par value $0.0001 per share, 75,000,000 shares authorized at December 31, 2023 and 2022; 50,770,520 and 49,546,727 shares issued and outstanding at December 31, 2023 and 2022, respectively	5	5
Additional paid-in capital	1,033,778	969,545
Accumulated deficit	(380,352)	(374,264)
Accumulated other comprehensive loss	(15,867)	(25,147)
Total stockholders’ equity	637,564	570,139
Total liabilities and stockholders’ equity	$ 719,923	$ 659,353

Debt	12 Months Ended
Debt	Dec. 31, 2023
Debt Disclosure [Abstract]
Debt	Debt In February 2018, the Company entered into the Loan and Security 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 were expensed and recognized as interest expense. In February 2021, the Company entered into another Loan and Security Agreement (the Loan and Security Agreement) with Silicon Valley Bank, under which the Company obtained a loan in the principal amount of $75 million. In June 2021, the principal amount, accrued interest, accrued loan fees, and prepayment fees related to this loan were paid in full. The unamortized debt issuance costs of $4.4 million were 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

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+ Details

Property and Equipment, Net (Tables)

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

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


	December 31,
	2023		2022
Equipment	$	3,169	$	2,645
Computer hardware and software	3,638		3,282
Tools and molds	2,315		1,735
Leasehold improvements	4,573		4,449
Furniture and fixtures	1,876		1,810
Construction in progress	6,054		413
	21,625		14,334
Less: accumulated depreciation and amortization	(10,865)		(7,536)
	$	10,760	$	6,798

Acquisition - Schedule of Pro Forma Information (Details) - Contura $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) $ / shares shares
Business Acquisition, Pro Forma Information [Abstract]
Net revenue	$ 181,643
Net loss	$ (77,535)
Net loss per share, basic (in USD per share) \| $ / shares	$ (1.79)
Net loss per share, diluted (in USD per share) \| $ / shares	$ (1.79)
Weighted-average shares used to compute basic net loss per share (in shares) \| shares	43,237,536
Weighted-average shares used to compute diluted net loss per share (in shares) \| shares	43,237,536
Acquisition-related costs
Business Acquisition, Pro Forma Information [Abstract]
Net loss	$ 4,400
Fair value adjustment to intangible assets
Business Acquisition, Pro Forma Information [Abstract]
Net loss	$ (1,300)

Cover - USD ($) $ in Billions	12 Months Ended
Cover - USD ($) $ in Billions	Dec. 31, 2023	Feb. 26, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	001-38721
Entity Registrant Name	Axonics, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	45-4744083
Entity Address, Address Line One	26 Technology Drive
Entity Address, City or Town	Irvine,
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92618
City Area Code	(949)
Local Phone Number	396-6322
Title of 12(b) Security	Common stock, par value $0.0001 per share
Trading Symbol	AXNX
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction	false
Entity Shell Company	false
Entity Public Float			$ 2.5
Entity Common Stock, Shares Outstanding		51,003,429
Documents Incorporated by Reference	The information that is required to be included in Part III of this Annual Report on Form 10-K is incorporated by reference to either a definitive proxy statement or an amendment to this Annual Report on Form 10-K to be filed by the registrant within 120 days of December 31, 2023. Only those portions of any such definitive proxy statement that are specifically incorporated by reference herein shall constitute a part of this Annual Report on Form 10-K.
Amendment Flag	false
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Entity Central Index Key	0001603756

Employee Benefit Plan (Details) - USD ($) $ in Millions	12 Months Ended
Employee Benefit Plan (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Contributions by employer	$ 2.8	$ 2.1	$ 1.9

Debt (Details) - Term Loan - USD ($)	1 Months Ended
Debt (Details) - Term Loan - USD ($)	Jun. 30, 2021	Jan. 31, 2021	Feb. 28, 2021
Term Loan One
Debt Instrument [Line Items]
Interest expense		$ 400,000
Unamortized debt issuance costs		$ 400,000
Loan and Security Agreement
Debt Instrument [Line Items]
Face amount of debt instrument			$ 75,000,000
Term Loan Two
Debt Instrument [Line Items]
Interest expense	$ 4,400,000
Unamortized debt issuance costs	$ 4,400,000

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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Amount of the cost of borrowed funds accounted for as interest expense.

+ References + Details

Nature of Operations and Summary of Significant Accounting Policies - Schedule of Reconciliation of Cash, Cash Equivalents, and Restricted Cash (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash and cash equivalents	$ 104,811	$ 238,846	$ 220,878	$ 241,181
Restricted cash	12,714	0
Total cash, cash equivalents, and restricted cash shown in the consolidated statement of cash flows	$ 117,525	$ 238,846	$ 220,878

Goodwill and Intangible Assets - Schedule of Estimated Future Amortization Expense (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Finite-Lived Intangible Assets, Amortization Expense, Maturity Schedule [Abstract]
2024	$ 8,962
2025	7,927
2026	7,783
2027	7,645
2028	$ 7,512

Stockholders' Equity - Common Stock Narrative (Details)	Dec. 31, 2023 vote
Common Stock
Class of Stock [Line Items]
Number of votes per share	1

- Definition

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-URI https://asc.fasb.org//1943274/2147481112/505-10-50-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 210
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(29))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480566/210-10-S99-1

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.6-03(i)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479886/946-10-S99-3

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.6-03(i)(1))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479886/946-10-S99-3

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.6-03(i)(2)(i))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479886/946-10-S99-3

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 3
-Subparagraph (SX 210.6-03(i)(2)(ii))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479886/946-10-S99-3

+ Details

Property and Equipment, Net - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 21,625	$ 14,334
Less: accumulated depreciation and amortization	(10,865)	(7,536)
Property and equipment, net	10,760	6,798
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	3,169	2,645
Computer hardware and software
Property, Plant and Equipment [Line Items]
Property and equipment, gross	3,638	3,282
Tools and molds
Property, Plant and Equipment [Line Items]
Property and equipment, gross	2,315	1,735
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	4,573	4,449
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,876	1,810
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 6,054	$ 413

Stockholders' Equity - Stock Option Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares)	0	0	46,000
Options grants in period, weighted average grant date fair value (in USD per share)			$ 32.93
Options outstanding weighted average remaining contractual term (in years)	5 years 2 months 12 days
Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 0.1
Weighted-average period of recognition of compensation cost (in years)	1 year 1 month 6 days
2014 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options and restricted stock-based awards remaining for future issuance (in 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 (in shares)	1,920,160
Stock reserved for issuance (in shares)	7,088,581

Income Taxes - Narrative (Details) - USD ($)	12 Months Ended
Income Taxes - Narrative (Details) - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Contingency [Line Items]
Effective tax rate (as a percent)	30.40%	4.20%	(1.00%)
Increase in valuation allowance	$ 100,000
Valuation allowance	96,880,000	$ 96,751,000
Unrecognized tax benefits	3,483,000	2,375,000	$ 3,404,000
Unrecognized tax benefits that would impact effective tax rate	100,000
Interest or penalties to be recognized for the period	0	$ 0
Domestic Tax Authority
Income Tax Contingency [Line Items]
Operating loss carryforwards	218,600,000
Operating loss carryforwards, subject to expiration	2,200,000
State and Local Tax Authority
Income Tax Contingency [Line Items]
Operating loss carryforwards, subject to expiration	$ 245,500,000

Acquisition

12 Months Ended

Dec. 31, 2023

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 initially assessed to be $7.6 million which was 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.


	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
Operating 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


	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.

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 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 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 income (loss).

At March 31, 2023, the Milestone was met and $35 million payment was made during the year ended December 31, 2023. The fair value of contingent consideration of $32.6 million is reflected in other current liabilities on the Company’s consolidated balance sheet at December 31, 2022.

Deferred tax liabilities

The Company determined the fair value of the deferred tax liabilities related to the acquisition to be $19.3 million.

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)




Net revenue	$	181,643
Net loss	$	(77,535)
Net loss per share, basic and diluted	$	(1.79)
Weighted-average shares used to compute basic and diluted net loss per share	43,237,536

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.

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, 2023	Dec. 31, 2022	Dec. 31, 2021
Contingent consideration:
Change in fair value included in net loss	$ 2,400	$ 22,230	$ 2,740
Level 3 \| Contingent Consideration Liability \| Fair Value, Recurring
Contingent consideration:
Balance at beginning of period	32,600	10,370
Change in fair value included in net loss	2,400	22,230
Payment made	(35,000)
Balance at end of period	$ 0	$ 32,600	$ 10,370

Income Taxes - Schedule of Components of Net (Loss) Income Before Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Domestic	$ 1,916	$ (24,466)	$ (56,105)
Foreign	(10,660)	(37,850)	(23,180)
Loss before income tax (benefit) expense	$ (8,744)	$ (62,316)	$ (79,285)

- 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
-Topic 944
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(11))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483586/944-220-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-30

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 5: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 31
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-31

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 235
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479557/942-235-S99-1

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section 25
-Paragraph 1
-SubTopic 20
-Topic 940
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481913/940-20-25-1

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(10))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483621/220-10-S99-2

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 942
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483589/942-220-S99-1

+ Details

Stockholders' Equity

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Stockholders' Equity

Stockholders’ Equity

Preferred Stock

As of December 31, 2023, the Company is authorized to issue 10,000,000 shares of preferred stock with a par value of $0.0001 per share. No preferred stock is issued or outstanding as of December 31, 2023 and 2022.

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 Delaware General Corporation Law (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 income (loss) is allocated as follows (in thousands):


	Years Ended December 31,
	2023		2022		2021
Research and development	$	9,362	$	6,734	$	5,980
General and administrative	11,687		7,965		8,079
Sales and marketing	23,487		17,319		11,105
	$	44,536	$	32,018	$	25,164

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. The 2018 Omnibus Incentive Plan was adopted upon our IPO and replaced the 2014 Stock Option Plan for future grants. As of December 31, 2023 and 2022, there were no stock options available for grant under the 2014 Plan.

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 7,088,581. As of December 31, 2023, there were 1,920,160 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,
	2023	2022

Options outstanding under the 2014 Plan	160,863	184,104

Options and restricted stock units outstanding under the 2018 Plan	884,617	1,045,924
Options and restricted stock-based awards remaining under the 2018 Plan for future issuance	1,920,160	2,694,622
	2,965,640	3,924,650

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.


	Years Ended December 31,
	2023	2022	2021
Expected term (in years)	—	—	5.46 - 6.00
Stock volatility	—	—	63.49%
Risk-free interest rate	—	—	0.53% - 1.16%
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. There were no stock option grants for the years ended December 31, 2023 and 2022. The weighted-average grant date fair value of options granted was $32.93 for the year ended December 31, 2021.

As of December 31, 2023, there was $0.1 million of total unrecognized compensation cost related to unvested stock options that is expected to be recognized over a weighted-average period of approximately 1.1 years.

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, 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

Options exercised	(364,352)	15.54		$	18,251	(1)
Options forfeited	(16,930)	31.80
Outstanding at December 31, 2022	1,046,610	18.81

Options exercised	(219,763)	19.34		$	9,076	(1)
Options forfeited	(12,067)	31.57
Outstanding at December 31, 2023	814,780	$	18.47	$	35,652	(2)
Options exercisable at December 31, 2023	810,400	$	18.25	$	35,642	(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.

The weighted-average remaining contractual term of options outstanding and exercisable is 5.2 years at December 31, 2023.

Restricted Shares Awards Activity

As of December 31, 2023, there was $54.1 million of total unrecognized compensation cost related to unvested RSAs that is expected to be recognized over a weighted-average period of approximately 1.9 years.

The following table summarizes RSAs activity:


	Number of Restricted Shares Awards	Weighted-Average Fair Value Per Share at Grant Date
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 shares awards granted	683,354	56.69
Restricted shares awards vested	(351,946)	42.15
Restricted shares awards forfeited	(112,576)	50.50
Outstanding at December 31, 2022	1,320,866	52.23
Restricted shares awards granted	635,766	57.28
Restricted shares awards vested	(540,441)	48.86
Restricted shares awards forfeited	(112,487)	54.88
Outstanding at December 31, 2023	1,303,704	$	55.86

Restricted Stock Units Activity

As of December 31, 2023, there was $3.7 million of total unrecognized compensation cost related to unvested RSUs that is expected to be recognized over a weighted-average period of approximately 0.9 years.

The following table summarizes RSUs activity:


	Number of Restricted Stock Units	Weighted-Average Fair Value Per Share at Grant Date
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
Restricted stock units granted	201,884	38.75
Restricted stock units vested	(268,930)	35.88

Outstanding at December 31, 2022	183,418	48.74
Restricted stock units granted	286,750	65.44
Restricted stock units vested	(215,968)	50.71
Restricted stock units forfeited	(23,500)	$	75.07
Outstanding at December 31, 2023	230,700	$	70.20

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

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

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


	Years Ended December 31,
	2023		2022		2021
Domestic	$	1,916	$	(24,466)	$	(56,105)
Foreign	(10,660)		(37,850)		(23,180)
Total	$	(8,744)	$	(62,316)	$	(79,285)

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,
	2023		2022		2021
Current:
Federal	$	—	$	—	$	—
State	409		76		211
Foreign	1,433		174		26
Total current income tax expense	$	1,842	$	250	$	237
Deferred:
Federal	$	—	$	—	$	(422)
State	—		—		(117)
Foreign	(4,498)		(2,868)		1,084
Total deferred income tax (benefit) expense	$	(4,498)	$	(2,868)	$	545
Total	$	(2,656)	$	(2,618)	$	782

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,
	2023		2022		2021
Tax at statutory federal rate	21.0	%	21.0	%	21.0	%
State tax, net of federal benefit	(0.5)	%	1.0	%	3.8	%
Excess tax benefits related to stock-based compensation	46.6	%	8.3	%	9.4	%
Non-deductible stock-based compensation	(75.1)	%	(1.7)	%	(1.4)	%
Tax rate change	9.2	%	1.0	%	(5.2)	%
Net operating loss adjustments	—	%	—	%	(7.9)	%

R&D tax credit, net of reserve	40.3	%	4.1	%	6.1	%
Change in valuation allowance	(0.9)	%	(19.6)	%	(24.5)	%
Change in fair value of contingent consideration	(6.4)	%	(7.3)	%	—	%
Other deferred adjustments	1.9	%	(0.8)	%	0.4	%
Other permanent differences	(9.7)	%	—	%	—	%
Other	4.0	%	(1.8)	%	(2.7)	%
Effective tax rate	30.4	%	4.2	%	(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,
	2023		2022
Deferred Tax Assets:
Stock-based compensation	$	4,761	$	4,855
Depreciation and amortization	120		(196)
Operating lease liabilities	6,454		2,169
Net operating loss carryforwards	62,680		76,013
Research and development credit carryforwards	22,690		7,332
Interest expense limitation carryforwards	9,107		5,457
Other	3,904		10,209
Total deferred tax assets	109,716		105,839
Less: valuation allowance	(96,880)		(96,751)
Total net deferred tax assets	$	12,836	$	9,088

Deferred Tax Liabilities:
ROU assets	$	(7,289)	$	(1,464)
Intangible assets	(16,250)		(24,036)
Total deferred tax liabilities	$	(23,539)	$	(25,500)

Net deferred tax liabilities	$	(10,703)	$	(16,412)

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, 2021	$	3,404
Additions based on tax positions related to the current year	574

Deductions for tax positions taken due to settlement	(1,603)
Balance at December 31, 2022	2,375
Additions based on tax positions related to the current year	852
Additions based on tax positions related to the prior year	339
Deductions for tax positions taken due to settlement	(83)

Balance at December 31, 2023	$	3,483

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Tax at statutory federal rate	21.00%	21.00%	21.00%
State tax, net of federal benefit	(0.50%)	1.00%	3.80%
Excess tax benefits related to stock-based compensation	46.60%	8.30%	9.40%
Non-deductible stock-based compensation	(75.10%)	(1.70%)	(1.40%)
Tax rate change	9.20%	1.00%	(5.20%)
Net operating loss adjustments	0.00%	0.00%	(7.90%)
R&D tax credit, net of reserve	40.30%	4.10%	6.10%
Change in valuation allowance	(0.90%)	(19.60%)	(24.50%)
Change in fair value of contingent consideration	(6.40%)	(7.30%)	0.00%
Other deferred adjustments	1.90%	(0.80%)	0.40%
Other permanent differences	(9.70%)	0.00%	0.00%
Other	4.00%	(1.80%)	(2.70%)
Effective tax rate	30.40%	4.20%	(1.00%)

Goodwill and Intangible Assets - Schedule of Finite-Lived and Indefinite-Lived Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets, Net:
Accumulated Amortization	$ (26,493)	$ (17,429)
Impairment	(287)	(287)
Intangible Assets, Net (Excluding Goodwill):
Gross Carrying Amount	116,500	116,500
Accumulated Amortization	(26,493)	(17,429)
Foreign currency translation adjustment	(8,345)	(12,531)
Intangible Assets, Net	81,375	86,253
Trade names and trademarks
Indefinite-lived Intangible Assets:
Gross Carrying Amount	19,700	19,700
Foreign currency translation adjustment	(1,482)	(2,398)
Intangible Assets, Net	$ 18,218	$ 17,302
Patent license asset
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period (in years)	8 years 8 months 15 days	8 years 8 months 15 days
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 1,000	$ 1,000
Accumulated Amortization	(1,000)	(1,000)
Impairment	0	0
Foreign currency translation adjustment	0	0
Intangible Assets, Net	0	0
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	$ (1,000)	$ (1,000)
Exclusive license asset
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period (in years)	4 years	4 years
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 3,300	$ 3,300
Accumulated Amortization	(2,420)	(1,540)
Impairment	0	0
Foreign currency translation adjustment	0	0
Intangible Assets, Net	880	1,760
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	$ (2,420)	$ (1,540)
Technology
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period (in years)	12 years	12 years
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 81,100	$ 81,100
Accumulated Amortization	(19,236)	(12,496)
Impairment	0	0
Foreign currency translation adjustment	(6,140)	(9,141)
Intangible Assets, Net	55,724	59,463
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	$ (19,236)	$ (12,496)
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Weighted-Average Amortization Period (in years)	12 years	12 years
Finite-Lived Intangible Assets, Net:
Gross Carrying Amount	$ 11,400	$ 11,400
Accumulated Amortization	(3,837)	(2,393)
Impairment	(287)	(287)
Foreign currency translation adjustment	(723)	(992)
Intangible Assets, Net	6,553	7,728
Intangible Assets, Net (Excluding Goodwill):
Accumulated Amortization	$ (3,837)	$ (2,393)

Stockholders' Equity - Preferred Stock Narrative (Details) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Equity [Abstract]
Preferred stock, authorized (in shares)	10,000,000	10,000,000
Preferred stock, par value (in USD per share)	$ 0.0001	$ 0.0001
Preferred stock, issued (in shares)	0	0
Preferred stock, outstanding (in shares)	0	0

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 9,064	$ 9,383	$ 7,241

Acquisition - Schedule of Intangible Assets Acquired (Details) - Contura $ in Thousands	Feb. 25, 2021 USD ($)
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 (in years)	12 years
Customer relationships
Business Acquisition [Line Items]
Fair value of finite-lived intangibles acquired	$ 11,400
Useful Life (in years)	12 years

Commitments and Contingencies

12 Months Ended

Dec. 31, 2023

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. In December 2021, the lease was amended to extend the expiration date to January 31, 2028, and in April 2023, the lease was amended to reduce the expiration date to March 31, 2024. Upon the execution of the amendments, which were deemed to be a lease modification, the Company reassessed the lease liability using the incremental borrowing rate for a collateralized asset of the same remaining term at the modification date and adjusted the carrying amount of ROU assets by the amount of the remeasurement of the liability. 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 entered into an operating lease for approximately 25,548 square feet of office space beginning on August 1, 2018, and expiring on October 31, 2027. In April 2023, the lease was amended to reduce the expiration date to December 31, 2024 and in September 2023, the lease was amended to extend the expiration date to July 1, 2025. Upon the execution of the amendment, which was deemed to be a lease modification, the Company reassessed the lease liability using the incremental borrowing rate for a collateralized asset of the same remaining term at the modification date and adjusted the carrying amount of ROU assets by the amount of the remeasurement of the liability. 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. 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. In April 2023, the lease was amended to reduce the expiration date to March 31, 2024 and in September 2023, the lease was amended to extend the expiration date to December 31, 2024. Upon the execution of the amendment, which was deemed to be a lease modification, the Company reassessed the lease liability using the incremental borrowing rate for a collateralized asset of the same remaining term at the modification date and adjusted the carrying amount of ROU assets by the amount of the remeasurement of the liability. The Company also reassessed the lease classification and concluded that the lease continues to be an operating lease. The Company uses these premises as its new principal executive offices and for general office space. The Company is utilizing its other currently-leased spaces 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. 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. In April 2023, the lease was amended to extend the expiration date to December 31, 2024 and in September 2023, the lease was amended to extend the expiration date to July 1, 2025. Upon the execution of the amendment, which was deemed to be a lease modification, the Company reassessed the lease liability using the incremental borrowing rate for a collateralized asset of the same remaining term at the modification date and adjusted the carrying amount of ROU assets by the amount of the remeasurement of the liability. The Company also reassessed the lease classification and concluded that the lease continues to be an operating lease. The Company uses these premises for general warehouse space.

In March 2022, the Company entered into an 18-month operating lease for approximately 3,276 square feet of warehouse space beginning on July 1, 2022 and expiring on December 31, 2023. In April 2023, the lease was amended to extend the expiration date to December 31, 2024 and in September 2023, the lease was amended to extend the expiration date to July 1, 2025. Upon the execution of the amendment, which was deemed to be a lease modification, the Company reassessed the lease liability using the incremental borrowing rate for a collateralized asset of the same remaining term at the modification date and adjusted the carrying amount of ROU assets by the amount of the remeasurement of the liability. The Company also reassessed the lease classification and concluded that the lease continues to be an operating lease. The Company uses these premises for general warehouse space.

In April 2023, the Company entered into a 120-month operating lease for approximately 145,960 square feet of office and warehouse space beginning on April 1, 2024 and expiring on March 31, 2034. The Company will use these premises as its new principal executive offices and for general office, manufacturing, and warehousing space. Under the terms of the lease, the Company is responsible for taxes, insurance, and maintenance expense. The lease contains certain scheduled rent increases. 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. The lease commenced on November 1, 2023, which was the date the Company was provided access to the leased property and control over its use. Therefore, the Company recorded $21.9 million of ROU assets and $23.1 million of operating lease liabilities related to this lease.

During the years ended December 31, 2023, 2022, and 2021, ROU assets obtained in exchange for new operating lease liabilities were $21.9 million, $0.1 million, and $1.0 million, respectively. As of December 31, 2023 and 2022, the ROU assets had a balance of $22.5 million and $6.2 million, respectively. The operating lease ROU assets are included within the Company’s non-current other assets, and lease liabilities are included in current or noncurrent liabilities in the Company’s consolidated balance sheets. During the years ended December 31, 2023, 2022, and 2021, cash paid for amounts included in operating lease liabilities was $2.5 million, $2.1 million, and $2.0 million, respectively. Amortization of the ROU assets was $0.9 million, $1.0 million, and $1.0 million for the years ended December 31, 2023, 2022, and 2021, respectively. As of December 31, 2023 and 2022, the weighted-average remaining lease term for the Company’s operating leases was 9.6 years and 4.9 years, respectively. The weighted-average incremental borrowing rate for a collateralized asset of the same remaining term used to determine the present value of the Company’s operating leases’ future payments was 5.9% and 7.1%, respectively.

Total lease costs for the years ended December 31, 2023, 2022, and 2021 are as follows (in thousands):


	December 31,
	2023		2022		2021
Lease cost
Operating lease cost	$	2,785	$	2,131	$	2,107
Short-term lease cost	85		80		95
Variable lease cost	527		203		191
Amortization of net lease liabilities	(1,667)		—		—
Total lease cost	$	1,730	$	2,414	$	2,393

Payments of operating lease liabilities as of December 31, 2023, are as follows (in thousands):


2024	$	2,296
2025	4,388
2026	4,011
2027	4,151
2028	4,291
Thereafter	25,130
	44,267
Less: imputed interest	(16,650)
	27,617
Less: operating lease liabilities, current portion	(1,777)
Operating lease liabilities, net of current portion	$	25,840

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 recorded related royalties of $2.5 million, $3.3 million, and $6.3 million during the years ended December 31, 2023, 2022, and 2021, respectively. Royalty expense is included in operating expenses in the consolidated statements of comprehensive income (loss). Accrued royalties of $0.8 million and $0.6 million as of December 31, 2023 and 2022, respectively, are included within accrued liabilities in the Company’s consolidated balance sheets. Royalty expense is declining because the Company’s F15 recharge-free SNM device is not an AMF Licensed Product that requires the payment of a royalty to AMF, including because it is not covered by any AMF patents licensed to the Company and for other reasons. For additional information, see Legal Matters section below.

Legal Matters

In addition to the matters described below, the Company may, from time to time, become a party to legal proceedings. Such matters are subject to many uncertainties and to outcomes of which the financial impacts are not

predictable with assurance and that may not be known for extended periods of time. When management has assessed that a loss is probable and an amount can be reasonably estimated, the Company records a liability.

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 U.S. 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 rechargeable 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 Federal Circuit recently reversed the decision of the Patent Trials & Appeals Board of the U.S. Patent & Trademark Office (PTAB) that the tined leads patents asserted against Axonics were valid, finding that the PTAB committed legal error in its analysis. The Federal Circuit remanded the matter to the PTAB for another review consistent with its opinion. Because of this development, the U.S. District Court has issued a stay on the litigation proceedings, pending the outcome of the proceedings before the PTAB. As a result, the jury trial previously scheduled for August 2023 has been postponed. The Federal Circuit also recently vacated the decision of the PTAB that certain claims of Patent Nos. 8,738,148 and 8,457,758 had not been shown to be invalid and the Federal Circuit remanded these matters for further proceedings for before the PTAB. The Company believes the allegations of the Medtronic Affiliates are without merit and is vigorously defending itself against them. 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 September 18, 2023, the Company commenced an arbitration against AMF with JAMS seeking, among other things, resolution that AMF’s purported attempt to terminate the License Agreement, dated October 1, 2013, was ineffective and that the Company does not owe any royalties to AMF for the Company’s F15 product and the Company was not required to pay royalties on its F15 product under the License Agreement. AMF responded to the arbitration demand and asserted multiple claims. On October 5, 2023, the Company and AMF entered into an interim agreement while the arbitration proceedings are pending. Pursuant to this interim agreement, the Company agreed to deposit into an escrow account an amount equal to 4% of the net revenues previously received for sales of the Company’s F15 product that are the subject of dispute, which the Company has determined is approximately $16 million from January 1, 2022 through December 31, 2023, with interest, and will continue to deposit the disputed 4% of net revenues of the Company’s F15 product with interest into the escrow account during the pendency of the arbitration proceedings. The Company has paid and, under this interim agreement, will continue to pay 4% royalties on rechargeable products. While the loss from this contingency is reasonably possible, the Company does not believe that such loss is probable. The Company believes that AMF’s claims are without merit and intends to vigorously defend against those claims, however, there can be no assurance as to the outcome of the arbitration.

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

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Revenue Disaggregated by Product and Geographic Market

The following table provides additional information pertaining to net revenue disaggregated by product and geographic market for the years ended December 31, 2023, 2022, and 2021 (in thousands):


	Years Ended December 31,
	2023		2022		2021
SNM net revenue
United States	$	284,846	$	216,861	$	153,837
International markets	6,959		5,130		3,753
	$	291,805	$	221,991	$	157,590
Bulkamid net revenue(1)
United States	$	59,036	$	40,178	$	12,660
International markets	15,538		11,533		10,040
	$	74,574	$	51,711	$	22,700
Total net revenue	$	366,379	$	273,702	$	180,290

_____________________________________________

(1) The acquisition of Bulkamid was completed on February 25, 2021. Reported revenue includes sales from February 26, 2021 onwards.

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,
	2023		2022		2021
Balance at beginning of period	$	321	$	355	$	465
Write-offs	(15)		(75)		(12)
Bad debt expense (recoveries)	136		41		(98)
Balance at end of period	$	442	$	321	$	355

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 years ended December 31, 2023 and 2022 (in thousands):




Liabilities
Contingent consideration:
December 31, 2021	$	10,370

Change in fair value included in net loss	22,230
December 31, 2022	32,600
Change in fair value included in net loss	2,400
Payment made	$	(35,000)
December 31, 2023	$	—

Schedule of Fair Value Hierarchy for Assets Measured on Recurring Basis

The following table presents the fair value hierarchy for those assets measured at fair value on a recurring basis as of December 31, 2023 and 2022 (in thousands):


	Fair Value Measurements at December 31, 2023
Assets(1):	Level 1		Level 2		Level 3		Total
Commercial paper	$	—	$	179,881	$	—	$	179,881
Corporate notes	—		18,279		—		18,279
U.S. government and agency securities	91,703		—		—		91,703
	$	91,703	$	198,160	$	—	$	289,863

_____________________________________________


	Fair Value Measurements at December 31, 2022
Assets(1):	Level 1		Level 2		Level 3		Total
Commercial paper	$	—	$	175,548	$	—	$	175,548
Corporate notes	—		4,675		—		4,675
U.S. government and agency securities	75,212		—		—		75,212
	$	75,212	$	180,223	$	—	$	255,435

_____________________________________________

Schedule of Available-for-sale Debt Securities By Significant Investment Category

The following table summarizes the Company’s cash equivalents and investments in available-for-sale debt securities by significant investment category as of December 31, 2023 and 2022 (in thousands):


	December 31, 2023
	Cost		Unrealized gains		Unrealized losses		Fair value
Cash equivalents:
Commercial paper	$	49,714	$	—	$	—	$	49,714
Corporate notes	—		—		—		—
U.S. government and agency securities	—		—		—		—
Total cash equivalents	$	49,714	$	—	$	—	$	49,714
Short-term investments:
Commercial paper	$	130,161	$	9	$	(3)	$	130,167
Corporate notes	18,272		18		(11)		18,279
U.S. government and agency securities	91,670		40		(7)		91,703
Total short-term investments	$	240,103	$	67	$	(21)	$	240,149

Total	$	289,817	$	67	$	(21)	$	289,863


	December 31, 2022
	Cost		Unrealized gains		Unrealized losses		Fair value
Cash equivalents:
Commercial paper	$	131,075	$	—	$	—	$	131,075
Corporate notes	2,013		—		—		2,013
U.S. government and agency securities	3,982		—		—		3,982
Total cash equivalents	$	137,070	$	—	$	—	$	137,070
Short-term investments:
Commercial paper	$	44,473	$	—	$	—	$	44,473
Corporate notes	2,664		—		(2)		2,662
U.S. government and agency securities	71,342		6		(118)		71,230
Total short-term investments	$	118,479	$	6	$	(120)	$	118,365

Total	$	255,549	$	6	$	(120)	$	255,435

Schedule of Reconciliation of Cash, Cash Equivalents, and Restricted Cash




Cash and cash equivalents	$	104,811
Restricted cash	12,714
Total cash, cash equivalents, and restricted cash shown in the consolidated statement of cash flows	$	117,525

- Definition

Tabular disclosure of investment in debt security measured at fair value with change in fair value recognized in other comprehensive income (available-for-sale).

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-9

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aa)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aaa)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

+ Details

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Carrying Amount of Goodwill

The change in the carrying amount of goodwill during the years ended December 31, 2023 and 2022 included the following (in thousands):


December 31, 2021	$	105,510

Foreign currency translation adjustment	(11,096)
December 31, 2022	94,414
Foreign currency translation adjustment	5,003
December 31, 2023	$	99,417

Schedule of Finite-Lived and Indefinite-Lived Intangible Assets

Intangible assets as of December 31, 2023 included the following (in thousands):


		December 31, 2023
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization		Impairment		Foreign currency translation adjustment		Intangible Assets, Net
Patent license asset	8.71 years	$	1,000	$	(1,000)	$	—	$	—	$	—
Exclusive license asset	4 years	3,300		(2,420)		—		—		880
Technology	12 years	81,100		(19,236)		—		(6,140)		55,724
Trade names and trademarks	Indefinite	19,700		—		—		(1,482)		18,218
Customer relationships	12 years	11,400		(3,837)		(287)		(723)		6,553
		$	116,500	$	(26,493)	$	(287)	$	(8,345)	$	81,375

Intangible asset as of December 31, 2022 included the following (in thousands):


		December 31, 2022
	Weighted-Average Amortization Period	Gross Carrying Amount		Accumulated Amortization		Impairment		Foreign currency translation adjustment		Intangible Assets, Net
Patent license asset	8.71 years	$	1,000	$	(1,000)	$	—	$	—	$	—
Exclusive license asset	4 years	3,300		(1,540)		—		—		1,760
Technology	12 years	81,100		(12,496)		—		(9,141)		59,463
Trade names and trademarks	Indefinite	19,700		—		—		(2,398)		17,302
Customer relationships	12 years	11,400		(2,393)		(287)		(992)		7,728
		$	116,500	$	(17,429)	$	(287)	$	(12,531)	$	86,253

Schedule of Estimated Future Amortization Expense

The estimated future amortization expense as of December 31, 2023, is as follows (in thousands):


2024	$	8,962
2025	7,927
2026	7,783
2027	7,645
2028	7,512

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Name Accounting Standards Codification
-Section 50
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Name Accounting Standards Codification
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-Paragraph 1
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1A

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-2

+ Details

Commitments and Contingencies - Schedule of Future Minimum Lease Payments for Operating Lease (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Lessee, Operating Lease, Liability, Payment, Due [Abstract]
2024	$ 2,296
2025	4,388
2026	4,011
2027	4,151
2028	4,291
Thereafter	25,130
Total lease payments	44,267
Less: imputed interest	(16,650)
Operating lease liability	27,617
Less: operating lease liabilities, current portion	(1,777)	$ (1,562)
Operating lease liabilities, net of current portion	$ 25,840	$ 7,555

Property and Equipment, Net

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

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


	December 31,
	2023		2022
Equipment	$	3,169	$	2,645
Computer hardware and software	3,638		3,282
Tools and molds	2,315		1,735
Leasehold improvements	4,573		4,449
Furniture and fixtures	1,876		1,810
Construction in progress	6,054		413
	21,625		14,334
Less: accumulated depreciation and amortization	(10,865)		(7,536)
	$	10,760	$	6,798

Depreciation expense of property and equipment was $3.4 million, $2.3 million, and $1.9 million for the years ended December 31, 2023, 2022, and 2021, respectively. The construction in progress balance primarily relates to the construction costs for the new principal executive offices and for general office, manufacturing, and warehousing space under an operating lease entered into in April 2023.

Stockholders' Equity - Restricted Shares Award Narrative (Details) - Restricted Shares Awards $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 54.1
Weighted-average period of recognition of compensation cost (in years)	1 year 10 months 24 days

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Nature of Operations and Summary of Significant Accounting Policies - Schedule of Available-for-sale Debt Securities By Significant Investment Category (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Debt Securities, Available-for-Sale [Line Items]
Cost	$ 49,714	$ 137,070
Fair value	49,714	137,070
Cost	240,103	118,479
Unrealized gains	67	6
Unrealized losses	(21)	(120)
Fair value	240,149	118,365
Cash and cash equivalents and short term investment, amortized cost	289,817	255,549
Cash and cash equivalents and short term investments, fair value	289,863	255,435
Commercial paper
Debt Securities, Available-for-Sale [Line Items]
Cost	49,714	131,075
Fair value	49,714	131,075
Cost	130,161	44,473
Unrealized gains	9	0
Unrealized losses	(3)	0
Fair value	130,167	44,473
Corporate notes
Debt Securities, Available-for-Sale [Line Items]
Cost	0	2,013
Fair value	0	2,013
Cost	18,272	2,664
Unrealized gains	18	0
Unrealized losses	(11)	(2)
Fair value	18,279	2,662
U.S. government and agency securities
Debt Securities, Available-for-Sale [Line Items]
Cost	0	3,982
Fair value	0	3,982
Cost	91,670	71,342
Unrealized gains	40	6
Unrealized losses	(7)	(118)
Fair value	$ 91,703	$ 71,230

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Deferred Tax Assets:
Stock-based compensation	$ 4,761	$ 4,855
Depreciation and amortization	120	(196)
Operating lease liabilities	6,454	2,169
Net operating loss carryforwards	62,680	76,013
Research and development credit carryforwards	22,690	7,332
Interest expense limitation carryforwards	9,107	5,457
Other	3,904	10,209
Total deferred tax assets	109,716	105,839
Less: valuation allowance	(96,880)	(96,751)
Total net deferred tax assets	12,836	9,088
Deferred Tax Liabilities:
ROU assets	(7,289)	(1,464)
Intangible assets	(16,250)	(24,036)
Total deferred tax liabilities	(23,539)	(25,500)
Net deferred tax liabilities	$ (10,703)	$ (16,412)

Nature of Operations and Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Principles of Consolidation	Principles of Consolidation The accompanying consolidated financial statements include the accounts of the Company and 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	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 2023 presentation.
Use of Estimates	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 disclosures 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. Such estimates and assumptions include the useful lives of property and equipment and intangible assets, the valuation of deferred income tax assets and liabilities, the valuation of contingent consideration liability, the valuation of stock-based compensation, the product returns reserve, the inventory obsolescence reserve and accounts receivable allowance for credit losses.
Revenue Recognition	Revenue Recognition Revenue recognized during the years ended December 31, 2023, 2022, and 2021 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 expected to be received 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. 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 $0.3 million and $0.2 million at December 31, 2023 and 2022, respectively, and is recorded as a reduction of gross revenue in its consolidated statements of comprehensive income (loss). Damaged or defective products are replaced at no charge under the Company’s standard warranty. For the years ended December 31, 2023, 2022, and 2021, the replacement costs were $0.1 million, $0.2 million, and $0.2 million, respectively. The replacement costs are recorded within the sales and marketing expenses in its consolidated statements of comprehensive income (loss). 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 liability at the time of revenue recognition and records it as a charge to sales and marketing expense. The warranty liability as of December 31, 2023 and 2022 was $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.
Allowance for Credit Losses	Allowance for Credit Losses The Company makes estimates of the collectability of accounts receivable in accordance with Accounting Standards Update (ASU) 2016-13, Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. The Company’s estimate of future credit 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 change in such a manner as to negatively impact their cash flows. 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.
Cash and Cash Equivalents and Restricted Cash	Cash and Cash Equivalents Cash equivalents consist of short-term, highly liquid investments purchased with a 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. The Company also holds cash in foreign banks that are not federally insured. The Company has not experienced any losses on its deposits of cash and cash equivalents. Restricted Cash Restricted cash consists of amounts held by an escrow account. On September 18, 2023, the Company commenced an arbitration against AMF with Judicial Administration and Arbitration Services (JAMS) seeking, among other things, resolution that AMF’s purported attempt to terminate the License Agreement, dated October 1, 2013, was ineffective and that the Company does not owe any royalties to AMF for the Company’s F15 product and that the Company was not required to pay royalties on its F15 product under the License Agreement. AMF responded to the arbitration demand and asserted multiple claims. On October 5, 2023, the Company and AMF entered into an interim agreement while the arbitration proceedings were pending. Pursuant to this interim agreement, the Company agreed to deposit into an escrow account an amount equal to 4% of the net revenues previously received for sales of the Company’s F15 product that are the subject of dispute. As of December 31, 2023, the Company has deposited approximately $12.7 million in the escrow account, and will continue to deposit the disputed 4% of net revenues of the Company’s F15 product with interest into the escrow account during the pendency of the arbitration proceedings. The Company has paid and, under this interim agreement, will continue to pay 4% royalties on rechargeable products. While the Company believes that AMF’s claims are without merit and intends to vigorously defend against those claims, there can be no assurance as to the outcome of the arbitration. For additional information, see Note 4.
Fair Value of Financial Instruments	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. Level 1 investments include U.S. government and agency securities, which are valued based on prices readily available in the active markets in which those securities are traded. Level 2 investments include commercial paper and corporate notes, which is valued on a recurring basis based on inputs that are readily available in public markets or can be derived from information available in publicly quoted markets. 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, and accounts payable, due to their short-term nature. 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. The Company’s business combination of Contura involved potential payment of future consideration that was contingent upon the achievement of certain product development milestones and/or contingent on the acquired business reaching certain performance milestones. A liability was recorded for the estimated fair value of the contingent consideration on the acquisition date. The fair value of the contingent consideration was remeasured at each reporting period, and the change in fair value was recognized within operating expenses in the consolidated statements of comprehensive income (loss). On February 25, 2021, the Company acquired Contura Limited and its Bulkamid product, a urethral bulking agent indicated for the treatment of female SUI. In consideration for the acquisition, the Company paid approximately $141.3 million in cash and issued 1,096,583 shares of our common stock. The agreement also provided that the Company may pay an additional $35 million in the event Bulkamid sales in any consecutive 12-month period exceed $50 million (the Milestone) before December 31, 2024, with payment due within 50 business days following the quarter in which the Milestone has been met.
Investment Securities	Investment Securities The Company classifies its investment securities as available-for-sale. Those investments in debt securities with maturities less than 12 months at the balance sheet date are considered short-term investments. Those investments in debt securities with maturities greater than 12 months at the balance sheet date 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 (loss) within the consolidated statements of comprehensive income (loss). There were no unrealized gains or losses during the years ended December 31, 2023, 2022, and 2021. 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 credit loss allowance 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, accretion and interest income are recognized when earned. Realized gains or losses are included in net loss and are derived using the specific identification method for determining the cost of securities sold. The Company holds investments in marketable debt securities that are classified and accounted for as cash equivalents or available-for-sale and are remeasured on a recurring basis. All of the Company’s available-for-sale debt securities are classified on the consolidated balance sheet as cash equivalents or short-term investments.
Inventory, Net	Inventory, Net Inventory is 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 inventory 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 expenses 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 ASC 730, Research and Development. Component materials and purchased products associated with clinical development programs are included in inventory and charged to research and development expenses 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 expenses 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 Company’s SNM systems 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.
Foreign Currency Translation	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, 2023 and 2022, all foreign currency translation gains (losses) have been unrealized and included in accumulated other comprehensive income (loss). Accumulated other comprehensive income (loss) consists entirely of losses or gains from translation of foreign subsidiaries at December 31, 2023 and 2022.
Property and Equipment	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 Goodwill represents the excess purchase price over the fair values of both tangible and intangible 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 value of its reporting unit using a combination of the discounted cash flow 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	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 initial public offering, 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 was 8.71 years. The asset has been fully amortized as of December 31, 2022. Exclusive license asset The intangible asset represents exclusive rights to existing technologies and development services from Micro Systems Engineering, Inc. pursuant to an agreement entered into on March 2, 2021. The rights and services were provided in exchange for 65,594 shares of common stock, 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 has been no intangible asset impairment charges during the years ended December 31, 2023, 2022, and 2021. Contura acquisition The intangible assets represent technology, trade names and trademarks, and customer relationships acquired from Contura on February 25, 2021. The trade names and trademarks have an indefinite life. The straight-line method over the period of estimated benefit is used to amortize technology. ASC 350-30-35-3, General Intangibles other than Goodwill, 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. The Company will review the intangible assets for impairment whenever an impairment indicator exists. There have been no intangible asset impairment charges during the year ended December 31, 2023. During the year ended December 31, 2022, as Bulkamid SARL ceased sales operations and did not recognize revenue and does not expect to recognize revenue in future periods, the Company wrote off the customer relationships intangible asset of $0.3 million related to this entity. The impairment expense was recorded within the general and administrative expenses in its consolidated statements of comprehensive income (loss).
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. There has been no intangible asset impairment charges during the years ended December 31, 2023 and 2021. There has been $0.3 million of intangible asset impairment charges during the year ended December 31, 2022. Indefinite-lived intangible assets are tested for impairment annually in the fourth quarter of the fiscal year and whenever events or changes in circumstances indicate that the carrying amount may be impaired. Impairment is calculated as the excess of the asset’s carrying value over its fair value. Fair value is generally determined using a discounted future cash flow analysis. There have been no impairments to indefinite-lived intangible assets during the years ended December 31, 2023, 2022 and 2021.
Leases	Leases In accordance with ASU 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. Operating lease right-of-use (ROU) assets 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 in similar economic environment, based on the information available at commencement date in determining the present value of future payments. The operating lease ROU assets also include any lease payments made and excludes lease incentives and initial direct costs incurred, and are included in other assets in the Company’s consolidated balance sheets. 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 Research and development costs are charged to operations as incurred. Research and development costs include employee compensation, including stock-based compensation, product development, including testing and engineering, royalty expense, and clinical studies to develop and support
Advertising Expense	Advertising Expense The Company expenses advertising costs as they are incurred.
Income Taxes	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 and a partial valuation allowance on certain foreign 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	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 three or 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 three or 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 is 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. If such targets are not met or service is not rendered for the requisite service period, no compensation cost is recognized, and any recognized compensation cost in prior periods will be reversed. In addition, the Company also grants market-based RSUs 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). Compensation cost is not adjusted if the market condition is not met, as long as the requisite service is provided.
Net Loss per Share of Common Stock	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.
Segment Reporting	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% of its products to customers in the United States. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In December 2023, the Financial Accounting Standards Board (FASB) issued ASU 2023-09, Improvements to Income Tax Disclosures (ASU 2023-09). The guidance is intended to improve income tax disclosure requirements by requiring (i) consistent categories and greater disaggregation of information in the rate reconciliation and (ii) the disaggregation of income taxes paid by jurisdiction. The guidance makes several other changes to the income tax disclosure requirements. This guidance is effective for annual periods beginning after December 15, 2024, with early adoption permitted, and is required to be applied prospectively with the option of retrospective application. The Company is evaluating the impact of the standard on its financial statements and related disclosures. In November 2023, the FASB issued ASU 2023-07 to require the disclosure of segment expenses if they are (i) significant to the segment, (ii) regularly provided to the CODM, and (iii) included in each reported measure of a segment’s profit or loss. Public entities will be required to provide this disclosure quarterly. In addition, this ASU requires an annual disclosure of the CODM’s title and a description of how the CODM uses the segment’s profit/loss measure to assess segment performance and to allocate resources. This guidance is effective for annual periods beginning after December 15, 2023 and interim periods beginning after December 15, 2024, with early adoption permitted, and is required to be applied retrospectively to all prior periods presented in the financial statements. The Company is evaluating the impact of the standard on its financial statements and related disclosures.

Nature of Operations and Summary of Significant Accounting Policies - Schedule of Fair Value Hierarchy for Assets Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	$ 240,149	$ 118,365
Commercial paper included in cash and cash equivalents	49,700	131,100
U.S. government and agency securities included in cash and cash equivalents		4,000
Corporate notes included in cash and cash equivalents		2,000
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	130,167	44,473
Corporate notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	18,279	2,662
U.S. government and agency securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	91,703	71,230
Fair Value, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	289,863	255,435
Fair Value, Recurring \| Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	179,881	175,548
Fair Value, Recurring \| Corporate notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	18,279	4,675
Fair Value, Recurring \| U.S. government and agency securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	91,703	75,212
Fair Value, Recurring \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	91,703	75,212
Fair Value, Recurring \| Level 1 \| Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	0	0
Fair Value, Recurring \| Level 1 \| Corporate notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	0	0
Fair Value, Recurring \| Level 1 \| U.S. government and agency securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	91,703	75,212
Fair Value, Recurring \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	198,160	180,223
Fair Value, Recurring \| Level 2 \| Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	179,881	175,548
Fair Value, Recurring \| Level 2 \| Corporate notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	18,279	4,675
Fair Value, Recurring \| Level 2 \| U.S. government and agency securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	0	0
Fair Value, Recurring \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	0	0
Fair Value, Recurring \| Level 3 \| Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	0	0
Fair Value, Recurring \| Level 3 \| Corporate notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	0	0
Fair Value, Recurring \| Level 3 \| U.S. government and agency securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value	$ 0	$ 0