Abstract: Vibration and noise control are important issues in engineering applications. Damping materials, with their excellent energy dissipation characteristics, can effectively suppress vibration and noise propagation. Polyurethane (PU) stands out among numerous damping materials due to its uniquely segregated microphase structure of soft and hard segments and highly designable molecular architecture, which enable flexibly tunable damping performance. However, conventional polyurethanes still face challenges in practical applications, such as narrow damping temperature ranges, limited functionality, and insufficient structural adaptability. In recent years, researchers have significantly enhanced the damping performance of PU through various strategies, including chemical copolymerization, filler compounding, and interpenetrating polymer networks. On this basis, damping polyurethanes have progressively evolved from single-performance materials toward multifunctional integration. By incorporating capabilities such as flame retardancy, hydrophobicity, self-healing, shape memory, and piezo-damping, PU-based damping materials can more comprehensively meet the performance requirements under complex service conditions. Furthermore, the introduction of advanced manufacturing technologies like 3D printing has promoted the integration of structure and function in damping polyurethanes. This review summarizes recent advances in the molecular design mechanisms, functional modification strategies, and advanced fabrication techniques of damping polyurethanes, and provides an outlook on future research trends, aiming to offer valuable insights for the development of high-performance damping materials.