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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 (PDE-5) 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.