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mass in testical sack

  I found a small round mass of tissue next to my left testical, not attached.
  I have noticed general pain and discomfront over the past few days.
  It seems to be more enlarged at night than during the day? In general, it is not
  tender to touch, but if pressed upon does cause pain.  It feels like a large lump of
  vessels or ligiments?  Is this normal? Shound I be tested for something?
  I am a 33 year w/m.
  Please help, Thanks
Dear Rob,
What you describe on testicular examination sounds like a varicocele.  A varicocele is a dilation of the veins of the pampiniform plexus of the spermatic cord--you can think of it as "varicose veins" of the spermatic cord.  Usually, a varicocele occurs on the left side.  Also varicoceles usually are less prominent while lying down.  Thus, when you are standing, a large varicocele appears as an irregular, worm-like mass beneath the scrotal skin overlying the spermatic cord.  It increases in size with abdominal straining.
The veins become dilated due to a malfunction of the valves of the venous system or to obstruction of the venous system.  In your case, you state that the mass is more prominent while you are lying down.  This tends to make me think that there may be an obstructive component.  This requires further evaluation.
Varicoceles also contribute to infertility because dilated veins do not regulate the temperate for the proper development of sperm, thus the sperm is less concentrated and has decreased motility.  In addition to impaired sperm quality, other indications for correction of varicoceles are pain (which is your symptom), cosmetic indications, and failure of the affected testis to grow.  There are several surgical methods to repair varicoceles.  Embolization, blocking the blood vessels, is another option.
Lastly, you may have a component of a left inguinal hernia.  This is when you have a weakness in the tissues which seperate your abdominal contents from the groin.  The mass you feel may be small bowel in your scrotum.  You would need physical examination to discern if this is present.  Surgical correction is indicated.  A spermatocele is also possible and your urologist will be able to diagnose this with a physical examination and possible transscrotal ultrasound.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely yours;
* Keyword:  scrotal mass; varicocele

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