A growing body of research suggests that selective alpha-blockers are a cost-effective and efficient way to treat ureteral stones. Silodosin, as a selective α-1a receptor blocker, plays an important role in stone treatment. Recently, Roger and other scholars at the University of California conducted a multicenter, randomized, double-blind trial to evaluate the efficacy of silodosin in stone evacuation, and found that silodosin was effective in facilitating the evacuation of distal ureteral stones, an article recently published in European Urology. The study included 239 patients with unilateral ureteral stones, ranging in size from 4-10 mm, who were randomized to the silodosin (8 mg) and placebo groups for 4 weeks. The primary outcome observed was spontaneous stone expulsion, and others were time to stone expulsion, admission to the emergency room, admission to the hospital, analgesic use, and incidence and severity of pain. It was found that the overall stone expulsion rates were not significantly different between the silodosin and placebo groups, at 52% and 44%, respectively. However, for distal ureteral stones, the stone removal rate was much higher in the silodosin group than in the placebo group (69% vs. 46%). The rates of stone expulsion for proximal and mid-ureteral stones were similar in both groups. There were no significant differences in emergency room visits, hospital admissions, or analgesic use. Although adverse events such as retrograde ejaculation, nausea, dizziness, headache and nasal congestion were more likely to occur in the silodosin group, most of the adverse events were mild. Although this multicenter, randomized, controlled study failed to find a significant difference in the overall rate of spontaneous ureteral stone expulsion between silodosin and placebo within 4 weeks of treatment, subgroup analyses suggest that silodosin significantly promotes the expulsion of distal ureteral stones. This may be related to the relatively high density of alpha-1 receptors in the distal ureter, and silodosin blocks alpha-1 receptors thereby relaxing the ureter and acting as an antispasmodic agent. The suitability of the application of silodosin is further confirmed by the fact that it was relatively well tolerated over a 4-week course of treatment, and the efficacy and safety profile of silodosin was similar in both men and women. The use of silodosin for mid- and proximal ureteral stones needs to be studied in greater depth.