Unidirectional ultrasonic guided waves (UGWs) play a crucial role in the nondestructive testing and evaluation (NDT&E) domains, offering unique advantages in detecting material defects, evaluating structural integrity, and improving the accuracy of thickness measurements. This review paper thoroughly studies the state of the art of unidirectional UGWs before presenting a comprehensive review of the foundational mathematical principles of unidirectional UGWs, focusing on the recent advancements in their methodologies and applications. This review introduces ultrasonic guided waves and their modes before looking at mode excitability and selectivity, signal excitation, and mechanisms used to generate and receive guided waves unidirectionally. This paper outlines the applications of unidirectional UGWs to reflect their effectiveness, for instance, in measuring thickness and in identifying defects such as cracks and corrosion in pipelines, etc. The paper also studies the challenges associated with unidirectional UGW generation and utilisation, such as multi-mode and side lobes. It includes a review of the literature to mitigate these challenges. Finally, this paper highlights promising future perspectives and develops directions for the technique. This review aims to create a useful resource for researchers and practitioners to comprehend unidirectional ultrasonic guided waves’ capabilities, challenges, and prospects in NDT&E applications.