Background <p>Gallbladder stones represent a common gastrointestinal disorder influenced by various metabolic and lifestyle-related risk factors. Serum uric acid (UA), a byproduct of purine metabolism, has been suggested as a potential contributor to gallstone formation, but the association remains unclear. This study aimed to investigate the relationship between serum UA levels and gallbladder stone prevalence in Korean women.</p> Methods <p>We conducted a retrospective, cross-sectional study of 19,329 Korean women who underwent abdominal ultrasonography as part of general health examinations. Participants were categorized into quartiles based on their serum UA levels. Multivariable logistic regression models were employed to evaluate the association between serum UA levels and gallbladder stone prevalence. Adjustments were made for potential confounders, including age, body mass index, lifestyle factors, and metabolic parameters.</p> Results <p>The mean age of the participants was 48.4 ± 10.3 years, with a mean serum UA level of 4.23 ± 0.91&#xa0;mg/dL. The prevalence of gallbladder stones increased significantly across serum UA quartiles, from 4.0% in the lowest quartile to 6.0% in the highest quartile (<i>p</i> &lt; 0.001). In the fully adjusted model, participants in the highest quartile had a significantly higher risk of gallbladder stones compared to those in the lowest quartile (OR: 1.430, 95% CI: 1.174–1.740, <i>p</i> &lt; 0.001).</p> Conclusions <p>Elevated serum UA levels were significantly associated with an increased prevalence of gallbladder stones in Korean women. This association remained significant after adjustment for multiple potential confounders. Further prospective studies are needed to clarify the temporal relationship between serum UA and gallstone development and to determine the clinical significance of this association.</p>