We performed multicenter prospective randomized study to determine the appropriate first line treatment modality for obstructing distal urethral stones (6-10 m).either medical expulsive therapy (MET) or ureteroscopy by comparing them safety and cost effectiveness. This prospective randomized study was done. On three thousand, one hundred and twenty four patients , one hundred and twenty four patients were withdrawn from the study, the remaining patients were randomized into two groups, group A (1500 patients were treated b y MET using Silodosin 4mg for Maximum 28days) and group B (1500 patients were managed using semirigid ureteroscopy. At each visit during the follow up we evaluate the primary and secondary outcomes. The average stone size was 7.5mm (6-10). Success rate for Group A and B was 90.7% and 93.3% respectively. The average hospital stay in Group (B) was 60 hours while no hospitalization needed in Group (A). The overall complication rate was 25.4% and 14.2% In-group A and B respectively. The cost in-group (A) showed highly statistically significant Value <0.05 compared with Group (B). Conservative treatment MET takes the advantage of outpatient clinic treatment, non-invasive cost effective, with statistically insignificant different as regard the safety and efficacy.