Abstract
<title>Abstract</title> <p> <bold>Purpose:</bold> This single-center retrospective study (2019–2023) analyzed 105 adult males with male genital lichen sclerosus (MGLSc)-related urethral strictures to investigate the association between histopathological inflammatory activity and disease duration, stricture length, and stricture location in male patients with late-stage MGLSc complicated by urethral stricture. <bold>Methods:</bold> Biopsies from glans lesions were evaluated for histopathological patterns by three pathologists using majority consensus. Inflammation severity was graded by lymphocytic density (<10, 10–49, ≥50 cells/HPF). Stricture characteristics—included length (≤2 cm, >2–7 cm, >7 cm), location (meatal, penile, bulbar), and disease duration (<10 vs. ≥10 years). <bold>Results:</bold> Histopathology revealed frequent epidermal changes (e.g., hyperkeratosis in 52%) and dermal sclerosis (85% in papillary dermis). Notably, 50% of cases showed minimal inflammation, while 23% exhibited severe band-like lymphocytic infiltration. Chi-square tests indicated a significant association between inflammation severity and stricture length (χ²=10.30, p=0.036), but not with location or duration alone. Multivariable ordinal logistic regression demonstrated that longer stricture length (OR=0.65 per unit, p=0.057), bulbar involvement (OR=0.40, p=0.001), and disease duration ≥10 years (OR=0.55, p=0.02) independently predicted lower inflammation severity. Additionally, pigmentary changes correlated with disease phase: pigment incontinence was linked to short duration and severe inflammation, whereas hyperpigmentation associated with chronicity and milder inflammation. <bold>Conclusion:</bold> These findings support a biphasic model of MGLSc: an early inflammatory phase with focal meatal strictures, followed by a late fibrotic phase characterized by extensive, less inflamed strictures. This highlights the need for stage-specific management strategies. </p>