Left-sided location, infertility, and palpable extratesticular mass are most associated with which condition?

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Dilation of the pampiniform venous plexus (varicocele) explains these findings. The left testicular vein drains into the left renal vein, often at a sharp angle and with higher venous pressure, making varicoceles more common on the left. The enlarged veins form a palpable extratesticular mass that feels like a “bag of worms” surrounding the testis. By raising the scrotal temperature and disrupting the testicular environment, a varicocele can impair spermatogenesis, leading to infertility or reduced fertility.

In contrast, a testicular torsion causes sudden, severe pain with a tender testis and is not typically associated with a palpable extratesticular venous mass or infertility. A hydrocele presents as a smooth, fluid-filled swelling around the testis rather than a vascular “bag of worms.” An epididymal cyst is a separate, usually painless cystic mass in the epididymis and does not typically contribute to infertility.