Pain and swelling in left testicle....please help

I'm sure this has been covered a bunch of times but I'm not sure there has been a definitive answer for what I'm experiencing....

About 10 years ago, I went to a urologist due to pain in my left testicle thinking it may have been from a hernia. I had an ultrasound done on it to make sure everything was ok and they said they found nothing. However I'm still experiencing pain (whether lifting or not) and even sometimes a shooting pain that shoots from my testicle up to my lower abdomen / stomach. It is considerably larger than the other testicle and of course hangs lower. I can squeeze it all that hard, due to the pain, but it may be irregularly shaped and there is also a dark vein at the bottom of it. Also above the testicle, what feels like a tube running up out of the testicle, gets very swollen and enlarged. I don't feel any hard lumps or anything but still get worried due to the pain still being around after all these years and the irregular size / shape of it. If anybody could offer me some help, it'd be greatly appreciated. Like a few others on here, I don't have insurance either. Would going to the ER be the cheapest route?

Thank you