Every year, the human impact on the world’s water sources becomes more pronounced. One of the triggers to this increase is the use of ineffective wastewater and sludge treatment systems. Recently, the number of studies of microwave processing in handling liquid municipal and industrial waste has increased. This paper discusses heat treatment, change in properties, decomposition of substances, removal of metals, demulsification, pyrolysis, biogas processing, disinfection, and other topics. The findings of European, Chinese, Russian, and other authors are summarised and presented in this review. In addition, the most notable Russian patents for microwave installations/devices and reactors suitable for a wide variety of applications are discussed. In this article, the authors look at microwave wastewater and sludge treatment from the perspective of practical application in various fields of human economic activity.