Objective of the study was to assess tamsulosin as an adjuvant treatment for patients with renal and upper ureteric stones after shock wave lithotripsy (SWL), regarding stone expulsion rate and analgesic dose. Patients and methods: This is a prospective randomized study carried out on 96 male patients with upper urinary tract stones who were divided randomly into 2 groups. Group I (47 patients): received Tamsulosin 0.4mg once daily plus diclofenac (50/75mg) oral or parenteral as needed for pain relief. Group II (49 patients): received only diclofenac (50/75mg) oral or parenteral for pain relief. SWL was performed with an electrohydraulic lithotripter. All patients were investigated two weeks after the SWL session by (K.U.B), and (U/S) to assess disintegration of stones or clearance and the need for further sessions with a maximum of 3 sessions per patient and follow up duration of 2 weeks after 3rd session. All patients with fragments 5mm or greater were considered as candidates for another SWL session. Patients with residual less than 5mm were considered as clinical insignificant fragment (CIF). Cases with no evidence of clearance or (CIF) after 2 weeks follow up of 3rd SWL session were considered failure. Reassessment and another treatment modality were chosen for the patient. Documentation of clearance rate, time and analgesics dose was noted for each patient in both groups. Results: The mean age for group I was 28.6 years and for group II was 29.5 years. The p-value was 0.980 and therefore, no significant difference in the age group was present. The mean stone size for group I was 13mm and for group II was 12.3.The p-value was 0.1071with no significant difference. In our study, total patients in group I had an expulsion rate of 80.9%. In contrast, group II had an expulsion rate of 57.1%. The p-value of this parameter was 0.022 which was found statistically significant. Considering the expulsion in patients with kidney stones, group I had expulsion rate of 80%. In contrast, group II had expulsion rate of 48.5%. The p-value of this parameter was 0.013 which was significant. Regarding patients with ureteric stones, the expulsion rate was 83.3% in group I and 75% in group II, having p-value of 0.947 which was not significant. The mean analgesic dose was 565 mg in group I and 1512 mg in group II. The p-value of this parameter was <0.001 which was significant. Conclusion: The use of tamsulosin as a medical expulsive therapy appears to augment the outcome of SWL by improving the overall stone clearance rate and time. Also, it seems to lower the post SWL analgesic dose required.