25 Archivio Italiano di Urologia e Andrologia 2018; 90, 1 ORIGINAL PAPER Comparison of three most frequently used alpha blocker agents in medical expulsive therapy for distal ureteral calculi, result of a retrospective observational study Aykut Bug ˘ra Sentürk 1 , Cemil Aydin 1 , Musa Ekici 1 , Muhammet Yaytokgil 2 , Ali Akkoc 3 , Mehmet Murat Baykam 1 1 Hitit University Corum Training and Research Hospital, Turkey; 2 Rize State Hospital, Turkey; 3 Alanya Alattin Keykubat University, Turkey. Purpose: In this study, we compared the effects of three agents frequently used in daily life for medical expulsive therapy. Materials and methods: A total of 143 patients meeting the cri- teria were included in the study. Patients were divided into three homogeneous drug groups which were tamsulosin group (n:48), alfuzosin group (n:47) and silodosin group (n:48). The time of stone expulsion, analgesic needs, side effects of the medicine and endoscopic intervention needs of the patients were recorded. Results: The rate of stone expulsion was 70.8% (n:34) in tamsu- losin group, 70.2% (n:33) in alfuzosin group, and 75% (n:36) in silodosin group. No significant difference was observed among the rates of stone expulsion in three groups, and the rates of stone expulsion were similar (p = 0.778). The duration of stone expulsion was significantly different in the groups (p = 0.012): the time of stone expulsion for tamsulosin was 2.33 ± 0.78 days longer than for Silodosin, indicating a significant difference. There was no significant difference between tamsulosin-alfu- zosin and silodosin-alfuzosin (respectively p = 0.147, p = 0.925). Conclusions: The results of this study showed that medical expulsive therapy by using alpha blocker agents is safe and efficacious. This option must be kept in mind for patients who do not ask for surgery as the first-step treatment for eligible patients. KEY WORDS: Urology; Ureter; Stone. Submitted 13 February 2018; 24 February 2018 Summary No conflict of interest declared. expulsive therapy, extracorporeal shock wave and lithotrip- sy (ESWL), retrograde ureterorenoscopy, antegrade per- cutaneous ureterorenoscopy, and laparoscopic and open ureterolithotomy (3). The location and the size of the stone, the availability of the technology, the treatment cost, the experience of the surgeon, and the preference of the patients are consid- ered when a treatment is chosen among the other alter- natives (4). The probability of spontaneous expulsion of the ureteral calculi has two factors: the size of the calculi and the anatomic location of the calculi. According to a meta- analysis, the rate of spontaneous expulsion of the stones smaller than 5 mm is 68% while it is 47% for the stones bigger than 5 mm and smaller than 10 mm (5). When anatomic location is considered, it is seen that 71% of the distal ureteral calculi and 22% of the proximal ureteral cal- culi expulse spontaneously (6). Therefore, spontaneous expulsion of the stone protects the patient from surgical intervention, anesthesia risk and additional costs, who does not have infection history and who has pain control and small size of calculi. By this way, with the under- standing of the ureter physiology in detail, the concept of medical expulsive therapy has been developed in order to make the spontaneous expulsion of the stone easier. The purpose of the medical expulsive therapy is to increase the spontaneous probability of the stone expul- sion by enabling relaxation in the ureter smooth muscle structure and eventually it reduces the pain level and fre- quency felt by the patient, shorten the time of stone expulsion, reduces the need of operation, prevents the risk and complications related with the operation and reduces the cost of the treatment. Some main points need attention during the medical expulsive treatment. The most important two factors of them are the location of the calculi in the ureter and the size of the calculi. The maximum upper limit recommended for the treatment of the medical expulsive is 10 mm (7). Many treatment alternatives are available for medical expulsive treatment. Calcium channel blockers, alpha blockers, phosphodiesterase type 5 inhibitors and corti- costeroids are the most frequently used drugs. In the guide of European Society of Urology, it is mentioned that DOI: 10.4081/aiua.2018.1.25 INTRODUCTION Urolithiasis is one of the most common disorders of uri- nary tract affecting about 5%-10% of the population. Renal stones are most prevalent between the ages of 20 and 40 years and are three times greater in men than women (1). Women typically excrete more citrate and less calcium than men, which may explain the higher incidence of stone diseases in men. Twenty-two percent of all urinary tract stones are found in ureter, of which 68% are seen in the distal ureter (2). The treatment of urinary stones basically varies depend- ing on the anatomic location of the stone, the size of the stone and the factors related with the patient. The treat- ments of the ureteral calculi are observation, medical