Vascular endothelial is considered to be a key factor in the pathogenesis of erectile dysfunction (ED). The purpose is to reveal the research trend of the field of ED and vascular endothelium. In addition, the goal is to discover the role and mechanism of vascular endothelium in ED. Bibliometrics and visualization methods based on CiteSpace were selected. We conducted the co-authorship analysis of countries, institutions and authors, co-occurrence analysis of keywords, and co-citation analysis of literature and authors through CiteSpace 6.1.R3. 1431 articles from Web of Science Core Collection (WOSCC) were included in the analysis from 1991 to 2022. We found some influential and cutting-edge nodes in each map, including countries, institutions, authors, articles, etc. Stem cell, therapy, oxidative stress, cavernous nerve injury, radical prostatectomy, fibrosis, erectile function, mesenchymal stem cell, and apoptosis may be hot keywords. In conclusion, the efficacy and mechanisms of stem cells and their derivatives in the treatment of diabetes (DM) ED and cavernous nerve injury (CNI) ED are the future research trends. Stem cells therapy for ED is a hot spot in this field, which side notes that stem cells may work mainly through improving endothelial function. Vascular endothelial cells and VEGF may repair nerve and cavernous smooth muscle directly or indirectly, and finally polish up erectile function.

Objective: Several observational studies have recently been reported to suggest an association between gut microbiotaand erectile dysfunction（ED）. However, the causal relationship between gut microbiota and erectile dysfunction remains unclear. Therefore, the aim of this study was to clearly elaborate the causal relationship between gut microbes and erectile dysfunction. Methods: A two-sample Mendelian randomization study was conducted with summary statistics of the gut microbiota from the largest genome-wide association study Meta-analysis conductedby the MiBiogen Consortium (n=13, 266). ED patients’ information was collected from the European ancestry (6175 cases vs 217,630 controls). The causal relation between gut microbiota and ED was investigated using inverse variance weighting (IVW), MR-Egger, weighted median, weighted model, and MR-PRESSO. Reverse Mendelian randomization（MR） analysis was performed on bacteria found to be causally involved in erectile dysfunction in forward Mendelian random analysis. Cochran's Q statistic was employed to quantify the heterogeneity of instrumental variables. Results: IVW estimate indicates that Lachnospiraceae(OR=1.26, 95%CI=1.06 to 1.5, P=0.008), Oscillibacter(OR=1.2, 95%CI=1.04 to 1.39, P=0.016), Tyzzerella3(OR=1.14, 95%CI=1.02 to 1.27, P=0.024) and Erysipelotrichaceae UCG003(OR=2.05, 95%CI=1.54 to 2.56, P=0.006) were risk factor for ED. Sensitivity analyses were performed to verify the causal relations obtained by MR. The results of Cochran’s IVW Q test showed no significant heterogeneity of these IVs. Based on the results of the inverse MR analysis, no obvious causal effect of ED on intestinal flora was found. There was no significant heterogeneity found for instrumental variables or horizontal pleiotropy. Conclusions: This two-sample MR study found that gut microbes including family Lachnospiraceae、genus Erysipelotrichaceae UCG003、genus Oscillibacter、genus Tyzzerella3 were causally associated with ED. Further studies are needed to clarify the mechanism of gut microbes’s pathogenesis role in ED.