Technical infrastructures for water supply since antiquity have long been investigated by engineers, archaeologists, and historians, while hydraulic structures in rivers and brooks, in service before 1700, have hardly received any attention. The urgency for a better understanding of late medieval and early modern hydraulic activity in streams has recently arisen in Swiss flood research, which tapped into the copious serial inventories of municipal financial accounts. This contribution provides groundwork for further research. Based on sources from Fribourg (CH), Basel (CH), Regensburg (DE), and Wels (AT), the prevalent motives for the construction of contemporary stream works, their municipal management, and engineering techniques are investigated. The locally dispersed informations from sources and literature are integrated into a coherent overview of urban stream works in Central Europe for the period 1200–1700, including a typology according to hydraulic functions and physical structures. The results show that hydraulic construction in streams was led by principles of urban development, industry, and logistics, as well as protection against fluvial erosion and floods. The maintenance of stream works required large investments of financial, material, personnel, and organisational resources ranking among the highest expenses within municipal construction activity. Finally, the implication of anthropogenic stream interventions for pre-instrumental flood reconstruction is demonstrated with the example of Zurich (CH), and remaining desiderata within the field of research are stated.