Phyllanthus niruri (stone breaker) herbal therapy for kidney stones; a systematic review and meta-analysis of clinical efficacy, and Google Trends analysis of public interest.INTRODUCTION
 We used Google Trends to analyze its relative popularity in internet searches relative to conventional stone therapies.



Google Trends
Phyllanthus niruri (stone breaker) herbal therapy for kidney stones; a systematic review and meta-analysis of clinical efficacy, and Google Trends analysis of public interest.INTRODUCTION
 Phyllanthus niruri (P. niruri) is the most commonly listed active ingredient in commercially available herbal therapies for kidney stones, despite limited supporting clinical evidence.  We performed a meta-analysis to evaluate its efficacy in reducing stone burden.  We used Google Trends to analyze its relative popularity in internet searches relative to conventional stone therapies.


 MATERIALS AND METHODS
 A comprehensive literature search for controlled human studies containing data on the effect of P. niruri treatment on stone size and number was performed.  Pooled analysis of change in mean stone size and number with P. niruri was performed using a fixed-effects model.  Standardized mean difference (SMD) and 95% CI were reported.  Google searches in the United States within the 'Health' category, for topics 'Gale of the wind (P. niruri)', 'Extracorporeal shockwave lithotripsy' (ESWL), 'Ureteroscopy' (URS), 'Laser lithotripsy' (URSL) and 'Percutaneous nephrolithotomy' (PCNL), conducted between January 2014 and December 2018, were quantified.  Annual median relative search volumes (RSV; 0-100 scale) were compared using the Kruskal-Wallis test.  Post-hoc pairwise comparisons were performed using the Dunn test with Holm-Sidak adjustment.


 RESULTS
 Two studies met inclusion criteria.  P. niruri treatment resulted in significant decreases in mean stone size (SMD -0.39 cm, 95% CI = -0.68 to -0.09, p = 0.01) and number (SMD -0.38, 95% CI = -0.68 to -0.09, p = 0.01).  Median RSV for P. niruri was similar to that for ESWL, PCNL and URS through 2015, but was significantly higher than for ESWL and PCNL after 2015, and higher than for URS after 2016 (each p value p ≤ 0.0012).


 Limited clinical evidence supports modest efficacy of P. niruri in reducing stone burden, pending further study.  Public interest in P. niruri is growing within the United States, possibly reflecting a rising demand.
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