Hyperuricemia (HUA) is characterized by elevated levels of uric acid (UA) in the bloodstream, resulting from either excessive production or insufficient excretion of UA within the body. If left untreated, progressive or persistent HUA can lead to gout, causing significant harm to human health. Lactic acid bacteria (LAB), generally recognized as safe (GRAS) probiotics, have been shown to alleviate symptoms associated with gastrointestinal disorders such as irritable bowel syndrome and inflammatory bowel disease while supporting overall bodily functions and health. Recently, LAB has emerged as a potentially safe, cost-effective and efficient treatment for HUA. This comprehensive review aims to explore the current literature on the mechanisms through which LAB controls HUA. These mechanisms include suppressing purine metabolism, absorbing purine compounds, modulating microbiota to maintain host global purine homeostasis, reducing intestinal permeability, producing metabolites that alleviate HUA symptoms, promoting the expression of urate excretory proteins and inhibiting the expression of urate reabsorption proteins. The findings presented in this review provide a framework for further investigation into how probiotic LAB can alleviate HUA by influencing UA metabolism and elucidating their underlying action mechanisms.