Advancements in the use of enemas for treating urinary calculi

Urinary calculi are a prevalent condition within the urinary system, with treatment options ranging from traditional surgical and non-invasive methods to emerging alternative therapies. Recently, enema therapy utilizing traditional Chinese medicine (TCM) and Western medicine has gained attention as a non-conventional approach, offering unique advantages in managing urinary stones. Unlike conventional oral or surgical treatments, enema therapy enables direct colonic drug delivery, reduces systemic adverse effects, and may modulate gut microbiota and oxalate metabolism, thereby providing a novel mechanistic basis for stone prevention and expulsion. This paper provides a comprehensive review of the mechanisms, clinical applications, and safety considerations of TCM and Western medicine enema therapies. For the first time, we systematically integrate traditional theoretical frameworks with modern biomedical evidence, including microbiota-mediated oxalate degradation and detailed clinical operation parameters, to highlight the complementary and synergistic effects of combined TCM–Western medicine enemas. By analyzing both their individual and combined effects, this study aims to furnish clinicians with valuable insights to optimize treatment strategies and promote further development of enema therapy for urinary calculi.