Comparison and Efficacy of Alpha Blockers in MET we used the same dose of tamsulosin for MET. Yoon et al. [22] reported that the use of 0.2 mg tamsulosin produced a 25.7% increased stone expulsion rate and decreased ex- pulsion time for 3 days for stones ＜10 mm in diameter. In two other studies, 0.2 mg tamsulosin resulted in increased stone migration and an increased stone expulsion rate [23,24]. However, studies that have compared tamsulosin 0.2 mg and 0.4 mg are not much more prevalent than those that have compared a nonselective α-blocker and tamsulosin. In particular, to our knowledge, the present study is the first direct comparison of 10 mg alfuzosin, 0.2 mg tamsulosin, and 0.4 mg tamsulosin in the management of lower ureteral calculi. Comparison between the two tamsulosin doses and the 10-mg alfuzosin dose revealed no significant differences in expulsion rate or expulsion time. The expulsion time ob- served in this study was shorter than reported previously [25]. The higher expulsion rate observed with 0.2 mg tam- sulosin compared with 0.4 mg tamsulosin was likely not a statistical error caused by the small numbers of subjects, but rather that the lower dose of tamsulosin was sufficient to lower ureteral peristalsis. Similar to a previous study [26], all groups treated in this study with 0.2 mg tamsulosin, 0.4 mg tamsulosin, and 10 mg alfuzosin displayed no differences in postural hypotension. There were also no differences in dizziness, headache, and fatigue in these groups, which is also con- sistent with other studies [7,18,20]. Although tamsulosin has been linked to a higher incidence of retrograde ejacu- lation than the non-selective α-blocker alfuzosin [20], in our study, there was no significant difference in abnormal ejaculation between the groups. Whether the current re- sult is real is debatable. The short-term nature of this study and the less frequent sexual behavior of urinary stone pa- tients may have confounded the findings. When a single ureteral stone remains after 28 days of medical treatment, URS, SWL, and a second cycle of MET can be used for stone removal. A second cycle of tamsulosin therapy in nonresponders to a first cycle of MET may not significantly improve the expulsion rate [27]. Hubner et al. [28] reported that a maximum observation period of 30 days was chosen because a longer period could increase the complication rate by 20%. Thus, we advocate the need for aggressive stone removal such as URS or SWL when the first cycle of MET has failed. CONCLUSIONS The use of tamsulosin doses of 0.2 mg and 0.4 mg and of 10 mg alfuzosin for MET of single lower ureteral stones of 4 to 10 mm in diameter proved to be safe and effective as dem- onstrated by the increased stone expulsion rate, decreased expulsion time, and no significantly different adverse effects. 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