Introduction. Traditionally it is believed that the therapeutic effect of the hexane extract of Serenoa repens (HSRE) in patients with benign prostatic hyperplasia is realized due to its effect on prostate cells. However, in the literature there is data about the possible HSRE effect not only on the prostate, but also directly on the bladder. This paper summarizes data and analyzes the possible cellular mechanisms of HSRE action on the bladder under the development of infravesical obstruction (bladder outlet obstruction – BOO).

Materials and methods. Literature data from the PubMed and eLibrary.ru databases for a 25-years period related to the study of the pathogenesis of bladder dysfunction in the development of BOO, cellular and molecular mechanisms by which pathological and adaptive processes in bladder cells are realized, as well as the influence of HSRE on these processes are analyzed.

Results. The concept of the pleiotropic effect of HSRE on various links in the pathogenesis of bladder dysfunction caused by BOO has been formed. The main of which are: the antioxidant and anti-inflammatory effects of HSRE components, as well as the regulatory effect on cell growth and proliferation factors and transcription factors. All this reduces the cytotoxic effect of oxidative stress on the cells of the bladder developing in BOO, contributing to a more active proliferation of detrusor smooth muscle cells. The consequence of the complex action is to maintain the contractile function of the bladder in a state of adaptation to increased stress, due to BOO.

Conclusions. The present hypothesis about the direct effect of HSRE on the hypertrophied bladder and possible mechanisms of its therapeutic action is based on an understanding of the general biological mechanisms and allows us to explain better the results of previous clinical studies and to assess the prospects for expanding the scope of further drug application.