Introduction. Extracorporeal Shock Wave Lithotripsy (ESWL) is a modern, minimally invasive treatment method of renoureteral lithiasis. Standard medical expulsive treatment (MET) are calcium channel blockers and alpha-1 adrenergics. Recently, 5-phosphodiesterase (PDE5) inhibitors, have also demonstrated relaxation of ureter. Combined medication had a better results in ureteral relaxation and the passage of residual stone fragments. Material and methods. The study was performed on a group of 130 patients in the period October 2021 - January 2023, diagnosed with renoureteral lithiasis treated through ESWL with the Modulith SLK Storz Medical lithotripter. Patients were divided into two treatment groups. Group A administred tamsulosin 400 mcg daily and group B combined treatment with tamsulosin 400 mcg and tadalafil 5 mg daily. Results. The comparison of clinical data in the two groups was based on demographic characteristics, stone size, renal location, «stone free» rate. The mean size of the calculi was 13 mm in group A and 11 mm for group B. Patients included in the study didn’t undergo any urological interventions for accelerating the elimination of fragments. The «stone free» rate after 3 sessions of ESWL was 89%. The total expulsion rate was 81.4% in Group A compared to 93% in Group B. Conclusions. The results of the present prospective study demonstrated that patients receiving combined treatment had a higher stone-free rate compared to tamsulosin monotherapy.