All right, good morning. I'm Larry Biegelsen, the med tech analyst at Wells Fargo. It's my pleasure to host this session with the management team from Axonics. With us, we have Ray Cohen, the CEO, and Kari Keese, the CFO designate. This is the final, I think, med tech session at our 2023 healthcare conference. Thank you to everybody for attending and listening. In terms of format, it's gonna be fireside chat. Ray and Kari, thanks for being here. Thank you. Appreciate the invite. So, Ray, you know, I wanted to start with a couple big-picture questions. You've had a lot of success at Axonics since you IPO-ed a few years ago. Before jumping into the details, please remind us of your vision for the company. What do the next five years look like qualitatively? Well, look, we don't see a slowdown in terms of growth in the business, and it just gets back to the under-penetrated population that we're dealing with. You know, at this moment, there's probably 40 million patients who have moderate to severe incontinence symptoms, whether it be urge urinary incontinence or stress urinary incontinence, and we've just literally scratched the surface. You know, the fact that for sacral neuromodulation, the fact that Medtronic had a monopoly for many years, they didn't invest in creating awareness in the marketplace and so forth. But we've taken that mantle, and I dare say, no pun intended, we're stimulating the market at this point, and we don't see this slowing down. We think this is a huge opportunity, and we're gonna continue to put our heads down and execute. Okay. That's good to hear. And you recently announced a CFO transition with Kari taking over the role, after Dan's retirement. I guess CFO designate is the title right now. Can you talk about the transition and the overall timing? Introduce yourself and- Sure. So, I'm the CFO designate, I guess. Dan has announced his retirement, so he'll be leaving the company at the end of the month. I have been with Axonics for nearly 10 years now, so, this is not new to me. I think as far as transitions go, we'd expect this to be as seamless as possible. I've been working with Dan to build the team to, you know, bring the company to where it is today. So, you know, we expect a lot of consistency, a lot of the same philosophy on, you know, what we're doing here, guidance and forecasting, and all the same things. Great! Well, welcome. Congratulations. And she's obviously, we're a women's health company, so now we have a female CFO, so I'm thrilled about that as well. Good. It's important to note that I think, to just to amplify Kari's point, there's no change in philosophy here, right? Kari's been with us since the beginning. She's been VP of Finance and Accounting, so she understands, you know, everything about the business, and we also had the opportunity to work together in the previous company that Dan and I and Kari were involved in. So we have a very long, long-standing relationship, and Kari is extremely competent. That's great. Great to hear. So let's move to the sacral neuromodulation market. When we... You know, Medtronic recently reported, we aggregate the results, and, you know, we see two things. One is you took a lot of shares sequentially, which is not uncommon. And second, the U.S. market grew about 7% by RMS in calendar Q2, 10% in calendar Q1. So my question is, what drove the share gains, Ray? And where do you see that going in the second half of this year and beyond? What drove the share gains is that, A, we're 100% focused on this business. We have better products. There's more efficacy. They're longer-lived. We're easy to do business with as a company. I mean, we have an attractive alternative to the legacy Medtronic offering. You know, we also are 100% focused on incontinence treatments, and I think Bulkamid has the ability to treat stress urinary incontinence patients, who, by the way, a third of that, I mean, a third of the urinary urge incontinence patients, which is the sweet spot for sacral neuromodulation, also have stress urinary incontinence. It's not like we're a completely different population. I mean, so I think it's a combination of the fact of our focus, the quality of our support, you know, quality of the people in the field, the fact that we have, you know, two offerings to treat the whole patient. I think all those things conspire to help us continue to gain more accounts, right? And when we talk about market share, it's very important to understand there is no limit, right? It's not like, oh, there's a certain amount of budgets, there's a certain amount of patients or money that can be spent. This is a wide-open field. It's a greenfield opportunity. And so, you know, by you know, doing different things, by doing DTC, as an example, I mean, that's also helping to gain mindshare with not only patients, but with these practices as well. Ray, I forgot exactly when you launched. Was it 2018, 2019? We launched in November 2019, four months before the world ended. Three or four years to get to a third of the market. You're at about a third now, and you had to go through, obviously, you know, COVID. I'm sure that slowed you down. My question is, I know your goal is to get to over 50% share. Mm-hmm. How do you see the pace- Mm-hmm. of share gains between now and then? Well, we expect to be the market leader, by the end of this quarter. Oh, no, sorry, just kidding. ... You You told me you're going to be boring. I know. Well, I'm getting warmed up. So it's difficult to say exactly when, right? But I think that the pace should continue, and if you look at it and you go, well, we've gained about, you know, let's call it, you know, 12% of the market each year, I would expect that we'll continue at that pace. I do not see it slowing down, by the way. I mean, we've got more accounts converting to Axonics. We've got more revenue. Same-store sales are up, you know, in that 15% + range. That is a great indicator for us. So we see our customers doing more procedures than they were doing last year and the year before. So I think this is all moving in the right direction, and we're very optimistic about being able to declare at or let's just say, having you declare that, you know, we've reached over 50% of the uptake in this market. Okay. That's, that's a super helpful answer. The other aspect is the growth of the market. You know, aggregating it, it was, call it 9% in the first half. You know, it's interesting, we had a dinner with Medtronic, and they also expressed surprise that the market isn't growing faster, given all the new technology that's come from both- The market's not growing faster because Axonics is the only company doing anything to grow the market? Well- You forgot to say that part. Okay. Okay. That's, you know, I think, you know... Here's my message- Yeah ... to the CEO of Medtronic. Why don't you step up and spend some money and create some awareness in the marketplace and join us to grow the market? So this is not about technology, this is about awareness. I mean, most women, and I'm going to focus on women, 'cause 85% of the patients we treat for Sacral Neuromodulation are women, 100% are women in Bulkamid. But the fact is, they don't know that these therapies exist, which is why we're running, you know, these DTC ads on Facebook and on national television, and we're getting responses. This is running at about 550,000 people per quarter now are going to our Find Real Relief website, and somewhere in the neighborhood of 6%-7% of those individuals are filling out symptom surveys, raising their hand, saying, "Yes, I'm interested in seeing a specialist, and I'd like to get my problem resolved." And that's where we really kick in and try to get these people appointments and get them in the game. So, you know, that's what it takes. You know, the fact that there was a product in the marketplace for over 20 years, but it didn't work very well, wasn't long-lived, wasn't MRI-compatible, and nobody was doing anything to create awareness, this is why the market is where it is today. We're having to overcome the this legacy, and then also overcome a legacy with the physician implanters themselves, where they have perceived Sacral Neuromodulation as the therapy of last resort. So we've had to overcome that negative attitude about a product that was short-lived, not MRI-compatible, and fussy, and wasn't giving people the relief that it promised. And this is about technology. It's about, you know, how these products were designed and so on and so forth. So I think it's a new day, and the way we look at it is we've just scratched the surface. We're just getting started, and it's taken a little bit of time as a new company to get your sea legs under you and to get things really, really moving. We're super optimistic about growth in the marketplace, and we see things going to accelerate. The problem is quarter to quarter, it's difficult, right? Right. You know, you have all kinds of other issues, seasonality, all kinds of other things, that are going on, but, but we're firmly believe that this notion of, you know, in the neighborhood of, of 15% growth, we should see this over, over the arc of time here. Okay. So, you know, I know, I think, I think you said 10%-15% on the Q2 call. Yeah. Sounded like, you know, a little bit of an adjust. Look, 9% is not bad. Okay, I don't mean to make it... But it's not the 15, but you still feel confident in the 15. You're not gonna reach over it. Well, look, I can't. You know, we can only do what we can do. Right. Right? And when you control, pick a number out, Larry, we'll use your number, 35% of the market. Well, if I'm growing at 35%, 35% of the market's growing at 35%, 65% of the market is growing -2%, that's not very helpful. Right. So we would encourage Medtronic to, "Come on, step up, spend some money. Let's get this thing going," you know? you know. You're not backing off- It's weird. I'm moving- No, I'm not going to back off that because we believe over time that- Okay This thing is going to continue to accelerate. You can't control what- Right. You can only control- One side of it. Yeah. Yep. Okay. Fair enough. The accounts, Ray, just you touched on it a minute ago. You're at about 1,400 accounts, I think you've said? For Sacral Neuromodulation and about 1,600 accounts doing Bulkamid. There's 4,000 SNM prescribers in the U.S.? Correct. How do you reach the other, you know, almost 3,000? Well, we're doing it every single day, right? Every day, you know, we're bringing some of these providers to the Axonics side of the coin. I mean, that's what we're up to. So it's nothing new or different that we have to do. We'll just continue to go. Obviously, Bulkamid has been very helpful because that gets us into a lot of these competitive accounts. They get to know Axonics, and then it gets easier for them- Right to try us and then ultimately to switch. Remind us, so 1,400 SNM accounts for you, 1,600 Bulkamid, and so what's the overlap? So if... It's interesting. It's a good question. If they were doing Sacral Neuromodulation, I'd include them in the 1,400. So what that tells you is that we have a lot of our 1,400 accounts doing Bulkamid, but we have a lot of folks that have started on the Bulkamid program that are either doing Botox, that's the majority, right? They're not doing Sacral Neuromodulation. They were doing Botox to treat urinary urge incontinence, which is only, as you know, four- six-month treatment. And a bunch of them also are Medtronic customers.... So you can see that if we get in with Bulkamid, there's a super opportunity for us to convert that business over to Axonics over time. It just takes time and- but it's working. I mean, I guess of the 1,600 Bulkamid, is there a number you can share with us, the number there that are not doing Axonics? Half. Half. So about 800? Yep. Okay. You can see that, that's why we're bullish, right? We- You're having success in those accounts, like, bringing Sacral Neuromodulation to them? Very much so. Okay. Yeah. So that's low-hanging fruit for you? But look, if you're doing Botox, you did Botox because you thought sacral neuromodulation was not something you wanted to get involved in, given the, you know, all the legacy parameters. Right. Okay? So it takes more time, as you might imagine, to get a person who's doing Botox to get on- Sacral neuromodulation ... sacral neuromodulation. But if you're a Medtronic customer, and we're in there with Bulkamid, well, that's a lot more better low-hanging fruit for us. That makes sense. Yeah, so. On Bulkamid, Ray, you think it's going to be a $100 million product. I think this year, $73 million. Forgive me, I actually forgot. When do you expect it to be a $100 million, if you? You, you've been asking me this question now, I know. It's close. This is good. Larry has been asking me this question, like, when we first started, he's like: "Well, do you think it's possible one of these days- Right - you could do $100 million?" So look, this is hundreds of millions of dollars in our view. Hundreds of thousands of patients will be treated with Bulkamid. The question is, you know, how, how quickly- Hundreds of millions, you said. Hundreds of millions of- Dollars. Yes, because it's- Right. And hun- Sorry. Now you've missed it completely. I don't want to... What are you trying to- So, to do $100 million- Yeah You have to do 100,000 patients. Okay. Okay, so now we've cleared that up. Okay. Hundreds of thousands of patients will be treated with Bulkamid over the next couple of years. Okay. It'll be well over $100 million in revenue for us. Okay. And when you say hundreds of thousands of patients over the next couple of years, you're talking cumulative, not on an annual basis? No, no, annually. You can get to over 200,000- Yeah, just a question of- Patients per year. Yes, no doubt. You know- No doubt I feel like everyone- Let me give you this perspective. In 2015, 350,000 patients were treated with slings. That number has declined over time because of the mesh controversy and all that. Right. So you think about that. There's 20 million patients right now, women, who have moderate to severe stress urinary incontinence. 20 million of them, and we're talking about a few hundred thousand. So you can see the opportunity is much, much bigger than anybody has envisioned. Ray, I feel like everyone, people, the investment community sees Bulkamid as a very successful acquisition. Mm-hmm. But I think there's a little reluctance to give you full credit for it because people aren't sure about how the moat for Bulkamid. Is there, you know, a competitor going to come out, be able to come out with something similar? And what are you doing to enhance the product? So if it does become a $100 million or $200 million product, how can people get comfortable that that's, you know, sustainable? Well, look, we have obliterated all the competition for bulking. I mean, right now, we're selling, you know, three times as much Bulkamid as historically ever been sold for bulking. So Bulkamid now is the go-to product. It's also becoming, very quickly, first-line therapy for women with stress urinary incontinence. And the satisfaction level is significant, right? I mean, patients, this is- you're dry immediately once you get these injections. So there's a great level of satisfaction immediately on part of the patient, and then obviously, that rubs off nicely on the physician. They're doing more and more, every practice is doing more and more Bulkamid, right? So I mean, they see the results, they're asking patients. They're saying: "Well, we have two options. You can do a sling," and they explain, "or you can do Bulkamid, and there's no downside with Bulkamid. There's no surgery, there's no two weeks recovery, there's none of that." And people are saying, "Okay, fine, I'll try Bulkamid." Simple as that. And I think that it's gonna be really hard to displace that. I mean, you're getting results, it's easy, it's not expensive, it's covered by everybody's insurance. Will there be other tricks and tools and people wanting to get into this business over time? I imagine there will be. You shine a light on a market like we have, it's gonna attract competitors over time. But we're, we're you know, we're in the driver's seat on this one. And Ray, why? What are your thoughts about surrounding sacral neuromodulation with other, you know, products similar to Bulkamid, you know, adding more to the bag for incontinence? You have any ideas? No, I don't- Okay. but obviously... No, I, I'm, you think so. Bulkamid has been so successful for you. Would you consider doing more? Certainly, It's just a matter of finding the right products. Correct. Right. Right. I mean, that's the key. We, you know, there aren't a lot of great treatments for incontinence. We happen to have two that really, really work quite well. So, you know, we're constantly looking to see how we can enhance what we're up to, but we want to stay focused in this incontinence sector. The opportunities that seem to be more plentiful deal with BPH and other kind of men's health things. So we want to stay focused on what we're doing. There are some adjacent opportunities, even within Bulkamid, as a treatment for male incontinence, post-prostatectomy. There are some other things there, but, you know, we want to be opportunistic. If anything comes along that's in our sweet spot, then we're not going to be afraid to pull the trigger, but we don't want to be, you know, a serial acquirer just because. ... That's helpful. Ray, just switching gears to competition. BlueWind, you know, recently received FDA approval for its implantable tibial nerve stimulation system. At a high level, just remind us of why you're confident in your sacral neuromodulation business and don't consider ITNS to be a threat. I think if anything happens with ITNS, then it'll be the, you know, the rising tide, you know, floats all boats concept. When you talk about—You gotta talk about it specifically because embodiment matters. The BlueWind product, you put a lead into the ankle, and then you're gonna put a cuff around your ankle. You're gonna have to stimulate yourself for, you know, a couple of sessions per day, maybe an hour worth of this. That's what they did in their clinical study. So the thing that I've learned about humans and medical conditions is follows: One, everybody wants their problem fixed, meaning they want efficacy. Second, they want longevity of treatment effect. Third, they wanna do nothing. I don't see strapping myself onto some apparatus every single day for the rest of my life as a viable treatment. I don't see that people are gonna be compliant. We've learned that, right? I mean, whether it's drugs or any other things that require people to be actively involved in their therapy, you know, over time, they don't pan out too well. So, I don't see what... You have lower efficacy, you've got more stuff that you have to be involved in. You know, will there be some people that will choose to put something in their ankle? Yeah, maybe, but we don't-- we just don't see this as the right direction. You know, we have devices now that will give you 20 years of symptom relief, 20 years. And with our non-rechargeable device, they do nothing. So 20 years, I do nothing, I get my problem solved. I mean, that's a pretty strong proposition as opposed to... You know, people talk about sacral neuromodulation as if it's so complicated. I mean, the size of the incision in your body is about an inch. That's an incision where you make a pocket, and the IPG goes in. Like, why has all of a sudden this turned into the, "Oh, well, nobody wants this?" What? You know, yeah, if you're pitching an alternative solution, yeah, you're gonna throw stones at sacral neuromodulation, but this is the right therapy that gives people long-term relief, and ultimately will increase the quality of their lives without them having to be actively involved, which is the reason why we continued to move forward on our rechargeable technology, where now we have a very small device that is the size of an Andes Dinner Mint, exactly the same size, 5 cc in volume, that will last over 20 years in your body, and all you need to do is recharge it for 1 hour every six-12 months. I mean, you know what I mean? We have a whole suite now of products that basically will give you long-term relief, and you have very little to do about it, so. No change to your view on ITNS? You know, no. We're... Let me just be definite. I've said it. We're in the sacral neuromodulation business. We're all in on sacral neuromodulation. We're doing everything we can to enhance this technology to make it easier, et cetera, et cetera. We don't believe that ITNS is the way to go. It's interesting you say we're doing everything we can to enhance this technology. Yeah. There's a couple things you have ongoing. Yeah. But you have talked about, you know, running out of opportunities on the generator side to make improvements a couple of earnings calls ago. What are you doing to enhance the technology? Where do you see opportunity? Well, I think the opportunity. Look, we have. And the question about ITNS is this is. Everyone is just skipping over a lot of things. First of all, the reimbursement is not set, right? I mean, you know, okay, if CMS said, "We will pay you some facility fees," there's no doctor fees. This doesn't even kick in until 2024. Then you're gonna go through the Cat III nightmare for the next. Look at what Inspire went through. It took, what? five years before they could get coverage and so forth. So this is gonna take a long time before it becomes a viable alternative for physicians. Help me back to. What are you doing to improve- Oh, so. - the technology? Yeah. So what we're up to right now is we have to do an external trial. Those are the rules of the game, right? Insurance companies will not pay unless you do an external trial, and the patient has at least a 50% improvement in symptoms, or they won't pay for the permanent implant, okay? I'm going back to ITNS because I'm thinking, "Well, wait a minute. Are you saying insurance companies are just gonna pay? Just shove something in somebody's ankle, you don't know whether it's gonna be effective or not?" So this is a question to be answered, right? Nobody's asking that question, but it's the right question to ask. What we're doing is we're focused right now on the external trial experience. That's why we bought the Foramen Finder, right? This is a software tool where now you can take a static X-ray, put it into a software package, and it gives you the coordinates for exactly where the third foramen is, the S3 foramen in the sacrum. So that's gonna enhance and make things faster, easier for docs to be able to make the placement of the lead. We've also are modifying the external trial system so that we eliminate a bunch of cabling and all that, and now we have a covering that will allow a patient to take a shower, so waterproof. So what we're trying to do is we're focused on this external trial experience, make that more comfortable for patients, more efficient for physicians to you know to make it that much easier, right? Particularly for a new physician, right? If I'm a new physician, I've never done this before, these tools that we're coming up with are gonna make it easier for you to get into the game of sacral neuromodulation. So that's why we're doing that. Our physicians really appreciate, right? Our customers really appreciate this. The people that are not our customers yet are very much aware, right, that Axonics is taking the lead in terms of innovation and making things smoother, easier, longer-lived, and so forth. So that's what we're up to now. Those IPGs, I mean, you know, 20 years, I challenge anybody to make an IPG that can last a non-rechargeable device that can last 20 years in somebody's body. I mean, we've done a phenomenal job there, exceeded anybody's expectations. Ray, I've got it before, some financial questions, GLP-1s. What’s the correlation between incontinence and obesity, and how might GLP-1s impact sacral neuromodulation? You know, look, I think this is a difficult question for anybody to answer, but obesity is not the indication or does not what's driving urinary urge incontinence. It's an idiopathic problem. I think age has more of an impact in terms of, you know, whether you have urge urinary incontinence or not. So, you know, we don't anticipate much of a problem. What I have said is that we're looking at other new indications for sacral neuromodulation. That's another thing that we're up to. We want to be able to treat patients who have the opposite of fecal incontinence, which is constipation, which GLP-1s are gonna contribute significantly to that burden. How so? GLP-1s will make you constipated. There's no question about that. Okay. I'll just leave it at that. Okay. It could be, could be good for our business over time. Okay, interesting. Okay, so moving on, Ray, how are you thinking about just the cadence of revenue for the second half of the year? You know, historically, revenues in the third quarter have been kind of flat to slightly up. You know, how are you thinking about seasonality this year versus prior years? So I don't think it really changed. Nothing's really changed. You know, January and February are difficult months for elective procedures because people haven't met their deductibles. July and August are difficult months because people are on holiday, both on the provider side and the patient side. So that's kind of the way we look at it. You know, out of 12 months, there are four months that are not the best, and eight months is really where you got to go out and make the numbers happen. So we're right now entering that great time of the year, so we're really excited about finishing the year strong. Because you know, we're in September, and we have the fourth quarter ahead of us. So Q3 should look a lot like Q2. I mean, I think that's kind of where the guidance is, where the consensus is. I mean, might be some slight differentiation, but not significant. So things are going well for the company, and we're really optimistic about, you know, the closing out the year really strong. What kind of visibility do you get on, like, you know, surgeon schedules? How many months in advance? What kind of visibility do you have, like, you know, late into the rest of the year? So it's a lot faster than you might imagine, right? In other words, it's not like, well, here I have a patient who underwent an external trial in September, and, you know, I'm going to do the implant in November. That's not the way it works. So the vast majority of patients, from the time that they say yes and get the external trial, they're getting implanted within 30 days. So it's pretty dynamic, and it's relatively short term. You might have a month of good visibility? Yeah. I mean, we know, like, every team that we have in the field, which is partners between reps and clinical specialists, they are keeping their case calendar. So they know the case calendar for every physician they're working with and how that impacts their workflow, because we have to organize our support, right? Because we're there for every procedure. Our clinical specialists are there for every procedure. So they have to have visibility for what's happening, let's say, within the month of September. There may be some visibility into October, but that's probably a 45-day period of time that we have a sense about it. Thank you. Yeah. You know, staying with the financial questions, just how are you thinking about—what's the framework for 2024? You know, historically, you've talked about sacral neuromodulation growing 25%. Bulkamid seems to be doing well. What's the framework you could provide, you know, without giving guidance, obviously, for next year? It's an interesting question. What's the framework? Puts and takes, just any qualitative color. Mm-hmm. I mean, the 25% rate is quantitative- Yeah you know, goal that you've put out there. Yeah. Are you kind of still confident in that 25% number? Yes. Okay. I think that's enough. Anything else you wanted to say about- So you want to say anything, more? I would agree. We're not ready to put out specific 2024 guidance, right? But I think the 25% number, we're comfortable with, the 15% market growth. Nothing's changed from our perspective. I think then in the margins, we're talking. We've already done it, right? Last quarter was 75, a little over 75%. We think mid-70s% is the right margin profile for the company in 2024 as well. So we don't see anything disrupting the growth train that we're on, honestly. And that's kind of where we're at. It's just that, you know, I don't want to start to provide, you know, four months before the end of the year to provide guidance for 2024. I think that's a little premature for us. That's fair. And EBITDA, one positive data point in the second quarter was your Adjusted EBITDA positive and operating income positive as well in the second quarter. How are you thinking about carry profitability going forward? Yeah, we were really pleased with Q2. We had nearly a 20% Adjusted EBITDA margin. Our expectation is that that trend will continue into 2024, both on the Adjusted EBITDA margin and the operating profit margin. I think, you know, we expect, obviously, expenses will continue to increase as we grow the business. We'll be selective and strategic about expanding the expenses for growth, supporting the growth. But we fully expect a pathway to operating margins in the 20%+ range, 2024 and beyond. And I think in the past, you've talked about being profitable at $350 million-$400 million revenue? There we are. Right. So, I mean, consensus has you probably in that, you know, area in 2024. Is that Adjusted EBITDA positive or operating margin positive? In 2024? Well, on that $350 million-$400 million dollar- Well, I mean, that level of revenue, we're there at that level of revenue now, right? Right. We're gonna finish this year between $350 and $400. I think, consensus is, Neil, $358. Okay. So- So we're there. And we've already shown the leverage in the business is real, and I think next year, as Kari mentioned, I think we'll have an opportunity to be, you know, profitable on a full P&L basis. I mean, considering, you know, the continued growth in the company. So I think this is unusual, and we don't seem to be getting much credit, for, you know, running a high-growth company that actually is gonna make money and making money. I mean, it's shocking to me that, no... Last year, everybody wanted to know, "When are you gonna be profitable? When are you gonna be profitable?" Okay, well, here we are, but- You know what the next question is? No, what is it? What are your operating margin goals? Long-term operating margin goals. When are you gonna be... You don't have to give them now, but when are you gonna be prepared to give us more, you know, what your long-term operating margin goals are? Yeah, I mean, I would say we're not ready to put a specific timeline on the percentage, but we're comfortable with at the 20% + range for now. Over time. We've proven it, can happen and expect that over time as well. Okay. What didn't we cover, Ray, that you're excited about? Whatever this gentleman- Please, go ahead. Just a question on the Botox. Yeah. The Botox, referring from the Botox injection. That was a good procedure for the doctors, so do they felt like, "Hey, I've got coming in. It's referring to revenue injection? So it's a really good question. The doctors make a few hundred dollars for doing a Botox injection. The problem is that's not as recurring as you might expect because more than 60% of the patients drop out after two injections. So patients don't come back. They get tired of coming back for Botox injections, which last four-six months. Are they effective for urinary urge incontinence? Yes. But once again, you know, it's a short-lived treatment, and there are UTIs. We're talking in the teens. You get Botox, you have a 12%-15% chance you're gonna get a urinary tract infection. Yeah, that's not cool, right? And then a percentage of them will get some urinary retention as well, which is now the opposite of the problem. I was leaking, and now I can't void." So, it's interesting, but, you know, physicians aren't tracking those patients as well as we might as business people. So you know what I mean? Are they 100% present that the patients are not coming back? Well, no, we try to remind them of that. So it's a short-term solution. They're temporizing the patient. And why is Botox as popular as it is? It's because in 2013, Botox entered the market where Medtronic left the barn door wide open with a product that was not satisfying patients, not satisfying providers, and then people got on the Botox program. Now, we're gonna look to change that because we believe these patients deserve a long-term treatment. So are you factoring that into your social media, or do you you pair Botox with it or? Not yet. Not yet. We're not disparaging Botox in our social media or DTC efforts. So we're playing it straighter than that at the moment, just letting people know that there's therapies available. On that question, what is the competitive moat that you can sustain your 80% market share? What is the IP position? Are you talking about Bulkamid? [audio distortion] So yeah, we have some patents, but look, in the end of the day, I mean, people... Yeah, I mean, look, anybody, any company can do anything they want to do if they invest enough time and money and energy into it. It's a long road, right? You can't, you just pop up and say, "Oh, I have a product." No, you gotta go through, you know, all the steps of product development and then clinical studies, and, and then once you get something approved, now you gotta go out there and put a team out there and, and go out and compete. So I think the 400+ people we have in the marketplace are moat number one, right? And then the fact that the product works so well and has such high level of satisfaction is moat number two. You know, it's not like we haven't left the barn door open on Bulkamid. Now, you know, but if others want to come into the market, there's little we can do about it, right? I mean, but time will tell, and more customers, more treatments, more satisfied patients, I think, will conspire to help us. Yeah. John? You don't mind, let me go over. Yeah. So it's hard to hear you, John. Yeah. Oh, well, the Foramen Finder you bought, [audio distortion] rate itself in the current standard of care, or how much of a bump do you get by better Foramen Finder? So I think it's gonna be... We don't— First of all, we don't know, okay? So the real, the only real answer I can give you is we don't know what impact it's gonna have. We think it will make things easier, more efficient, and we think also will help us bring new docs to sacral neuromodulation because we have this kind of cool tool that they can use if they don't have a lot of experience. So, if this helps us convert, you know, 100 or more Botox physicians that are just doing Botox to sacral neuromodulation, well, that's gonna help, you know, obviously, you know, with our growth and our numbers. So, and if I can save physicians an extra few minutes on a difficult case, then that's a positive. So, the docs are very enthusiastic about it. I'm a little more reserved just because we, you know, we're first gonna go out there and do what we call Non-Significant Risk studies, right? So we wanna get this in the hands of some of our implanters, a couple of very experienced ones, a couple of inexperienced ones, and just observe how they're using it, how it's working, and all that. And then, you know, we'll be making our filing to the FDA as well. So, you know, we're optimistic. I wouldn't. We wouldn't have bought the technology if we didn't think it would make an impact, but it's too soon for us to make any strong comments about that. All right. I think we're gonna have to leave it there. All right. Ray and Kari, thanks for being here. Thank you. you. Thanks a lot.