OBJECTIVE： To compare the efficacy and safety of tamsulosin or nifedipine or racanisodamine in the treatment of lower ureteral calculi. METHODS：160 patients with lower ureteral calculi were randomly divided into group A （40 cases）， group B （40 cases）， group C （40 cases） and group D （40 cases）. All patients drank plenty of water to make daily urine output more than 2 000 ml. Based on it， group A orally received 0.4 mg Tamsulosin hydrochloride sustained release capsule， once a day. Group B orally received 10 mg Nifedipine tablet， 3 times a day. Group C orally received 10 mg racanisodamine tablet， 3 times a day. Group D received no other drugs except for increasing drinking. The treatment course for all groups was 2 weeks. Clinical efficacy， lithagogue time， lithagogue size， residual calculi size and the incidence of adverse reactions in all groups were observed. RESULTS： The total effective rate in group A was higher than group C， which was higher than group B and group D， the differences were statistically significant （P＜0.05）. Lithagogue time in group A was shorter than group B and group C， which was shorter than group D， the differences were statistically significant （P＜0.05）， while there was no significant difference between group B and group C（P＞0.05）. Lithagogue size in group A was more than group C， which was more than group B and group D， the differences were statistically significant （P＜0.05）， while there was no significant difference between group B and group D （P＞0.05）. Residual calculi size in group A was less than group B， which was less than group C and group D， the differences were statistically significant （P＜0.05）. And there were no severe adverse reactions in all groups. CONCLUSIONS： The efficacy of tamsulosin is superior to nifedipine and racanisodamine in the treatment of lower ureteral calculi， while nifedipine and racanisodamine show similar efficacy， with better safety.