Purpose : To compare the efficacy of silodosin , silodosin plus tadalafil and placebo as a medical expulsive therapy (MET) for distal ureteral calculi. Subjects & methods: This prospective randomized clinical trial was conducted on 120 renal colic patients with distal ureteric stones (5-10mm) over a period of 6 months (1st February , 2022 to 1st August , 2022 ) . The patients were randomly divided into three equal groups . Patients included in A received Placebo treatment once daily , in group B received Silodosin 8 mg once daily, while patients in group C received Silodosin 8 mg in combination with tadalafil 10mg once daily .Therapy was given for a maximum of 4 weeks . Stone free rate, time to stone expulsion, dose and duration of nonsteroidal anti-inflammatory drugs (NSAIDs), hospital visits due to pain, and adverse effects induced by the drugs were recorded. Results: The expulsion rate significantly differed between the studied groups (P < 0.001). Regarding expulsion time, there was a significant difference between the studied groups. The number of pain episodes showed an overall significant difference between the studied groups. The number of pain episodes showed an overall significant difference between the studied groups. Side effects significantly differed between the studied groups (P < 0.001). The predictors were Sildosin use, combined drug use, and stone size. Conclusion : Medical expulsive therapy for distal ureteric stone using Tadalafil in combination with silodosin is safe , well tolerated , and more effective than silodosin alone .