OBJECTIVE: To identify independent predictors of complete resolution in patients with pseudobiliary calculi and evaluate the effectiveness of different therapeutic strategies. METHODS: Clinical data were retrospectively analyzed from 264 patients with pseudobiliary calculi admitted to The First Hospital of Lanzhou University between January 2018 and December 2019. Patients were categorized into complete resolution group (n = 43) and persistent group (n = 221) based on discharge CT findings. Univariate and multivariate logistic regression analyses were performed to assess the impact of demographic characteristics, laboratory parameters, comorbidities, and therapeutic interventions on prognosis. RESULTS: Among 264 enrolled patients, 43 (16.29%) achieved complete resolution while 221 (83.71%) showed persistent calculi. Univariate analysis revealed significant differences between groups in gender (χ CONCLUSION: Our research indicates that, unlike chronic cholelithiasis, pseudolithiasis exhibits uniqueness and temporality. The underlying inflammatory gallbladder diseases and their treatments may facilitate the rapid resolution of pseudolithiasis, while factors such as viral hepatitis and decompensated cirrhosis may affect liver function and bile composition but do not appear to directly contribute to the occurrence of pseudolithiasis. Furthermore, differences in sex hormone levels may result in a higher rate of short-term resolution of pseudolithiasis in male patients compared to females. These findings provide preliminary evidence for the prevention and management strategies of pseudolithiasis.