Despite various described methods of reconstruction after upper ureteral injury, many cases are complex and remain a surgical challenge. Careful preoperative evaluation and planning are crucial in the selection of the appropriate procedure, particularly in patients in whom preservation of the renal mass is imperative. We report a case of severe upper ureteral injury and subsequent fibrosis, with no usable renal pelvis and focal upper pole dilation, that was managed with renal inversion and upper pole ureterocalicostomy. The option of autotransplantation was provided by laparoscopic nephrectomy and ex vivo reconstruction, minimizing patient morbidity and maximizing a successful outcome. This case illustrates the expansion of laparoscopy from the mere extirpative to a role in complex reconstruction. To our knowledge, this reconstructive strategy has never been previously reported and may be applicable in a limited number of situations.