Minimally invasive therapies for urolithiasis including extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrostolithotomy are highly efficacious, yet expensive. Medical expulsive therapy offers a cost-effective, nonsurgical approach for appropriate patients with ureteral stones. The use of hormones, nonsteroidal anti-inflammatories, calcium channel blockers, corticosteroids, and adrenergic alpha antagonists all have been proposed as a way to enhance stone passage. In view of the available clinical trials and meta-analysis, patients with distal ureteral stones measuring 1 cm who are candidates for observation deserve a trial of medical expulsive therapy. Nifedipine, a calcium channel blocker, and adrenergic alpha antagonists have been proven to be clinically efficacious, safe, and well tolerated as medical expulsive agents.