Introduction: In up to 50 percent of cases, expectant treatment may result in spontaneous 
stone expulsion. The therapeutic potential of α-adrenergic blockers for ureteral stone disease 
was investigated, prompted by α-receptor detection in ureteral smooth muscle cells improves 
the passage of larger ureteric stones (5-10 mm).A newly launched phosphodiesterase-5 (PDE5) inhibitor, tadalafil, has emerged that acts on the smooth muscle NO / cGMP and can be 
used as expulsive therapy. Aim of the work: To assess the impact of Tadalafil vs. 
Tamsulosin, as medical expulsive therapy of solitary unilateral lower ureteric stone less than 
1 cm. Patients and Methods: Our prospective, randomized, placebo-controlled, comparative
clinical study at Nephrology and Urology Minia University Hospital, included 99 patients 
who randomized into 3 equal groups, 33 patients in each group.First group received Tadalafil 
5 mg, second group received Tamsulosin 0.4mg, third group was control group (placebo).
Results: The stone expulsion rate was 78.8%, 81.8% and 54.5% respectively, with a 
significant difference between group (A,B) and group (C). Mean days till stone passed was 
(11.17±5.1), (10.27±4.17) and (15.7±3.66) respectively, the difference is statistically 
significant.