External genital morphology and urethral stricture severity in adult male genital lichen sclerosus: a single-center retrospective study of 134 cases.

PURPOSE: Male genital lichen sclerosus (MGLSc) is a chronic inflammatory condition that can progress to urethral stricture, yet the relationship between external genital morphology and stricture severity remains poorly characterized.

METHODS

A retrospective analysis of 134 patients with MGLSc-related urethral stricture (2016-2024) was conducted at a single center. Eight external morphological features were assessed via photographic review. Stricture severity was graded using the LSE classification system. Associations were examined using multinomial logistic regression, linear regression, and latent profile analysis (LPA).

RESULTS

Hyperpigmentation was observed in 56.7% of cases. Foreskin thickening (50%) and frenulum disappearance (91.8%) were common structural alterations. In adjusted analyses, absence of hyperpigmentation was associated with lower odds of bulbar involvement relative to penile-confined stricture (OR = 0.134, p = 0.045). Foreskin thickening and foreskin-glans adhesion were significantly associated with stricture score. LPA identified two subgroups stratified by disease duration; within each subgroup, the pattern of associations between morphological features and stricture severity differed. In the short-duration subgroup, frenulum shortening, meatal shape, and meatal location showed significant associations; in the long-duration subgroup, only foreskin thickening remained significant.

CONCLUSION

External genital morphological features showed associations with urethral stricture characteristics in this exploratory analysis, and these associations appeared to vary by disease duration. These findings may offer clinical clues for preliminary risk stratification in MGLSc patients but should be interpreted with caution given the retrospective, single-center design and the absence of external validation. Prospective multicenter studies with standardized morphological assessment protocols are warranted to confirm these observations.