Abstract: To meet the strategic needs of deep-sea exploration and security, large scale UUVs with long-endurance, long-range, high-speed, and low-noise capabilities have become the commanding height of marine technology competition. This paper systematically reviews the technology genealogy of these UUVs, mainly discusses the core challenges of Multidisciplinary Design Optimization (MDO) encountered in achieving comprehensive and high-performance objectives. The study reveals that performance metrics across disciplines such as energy and propulsion, acoustic stealth, hydrodynamics structure, and intelligent control are deeply coupled and mutually constraining, and it is difficult for traditional sequential design methods to achieve global system optimum. To address this, the paper constructs a “multi-dimensional measurement system for overall performance” encompassing equivalent endurance, equivalent payload, and vacancy ratio, this system aims to shift the design goals from meeting performance metrics to seeking the optimal multi-dimensional performance combination, and provides a scientific basis for evaluating the performance of the overall design. Building upon this framework, the paper systematically compiles the general parameters and technical features of internationally mainstream large scale UUVs, and it provides an in-depth analysis of solution paths to overcome challenges such as long-endurance reliability, the energy bottleneck, and autonomous control in ocean weak observation-communication environments. Finally, the review concludes by outlining future development trends towards intelligent, systematic, and cross-domain cooperative, and points the key to promoting the leapfrog development of the future performance of large scale UUVs, and it provides a systematic reference for the technological innovation and engineering practice of large scale UUVs.