Modern lifestyle and diet have increased the incidence rate of uric acid (UA) metabolism-related diseases like hyperuricemia (HUA) and gout, posing heavy economic burden to individual patients and their families and the society. UA metabolism is a complex physiological process involving the kidney, intestine, and other organs. A number of factors together regulate UA metabolism, including genetics, diet, hormones, and the gut microbiota. This review summaries the gut microbiota features in subjects with HUA and gout, and the therapeutic effects of implementing microecological therapies (probiotics, prebiotics, or fecal microbiota transplant) that target modulate the gut microbiota and its downstream metabolism on the disease. Current evidence shows that these strategies are safe and promising in alleviate inflammation, reduce UA, and restoring a healthy gut microbiota in subjects with UA metabolism-related diseases. However, most clinical data are generated by animal studies. Therefore, we propose that vigorous human intervention trials should be conducted in the future to evaluate the therapeutic effects of microecological therapies in managing HUA and gout.