When patients have their bladder removed due to cancer, doctors need to watch out for hidden nutrition problems. A new study of 25 patients found something surprising: even when weight stayed the same in the first week after surgery, patients weren’t actually getting enough food and protein. By two weeks, patients lost weight, and those who needed a feeding tube lost even more. The research shows that doctors can’t just look at the scale to know if patients are doing okay nutritionally—they need to check what patients are actually eating, how they’re feeling, and their body’s fluid levels too.

The Quick Take

  • What they studied: How well patients eat and maintain their nutrition after having their bladder surgically removed, and whether weight changes accurately show if patients are getting enough nutrients
  • Who participated: 25 patients who had bladder removal surgery and were treated using a special recovery program designed to help them heal faster
  • Key finding: Weight stayed the same during the first week after surgery, but patients weren’t eating enough protein and calories. By day 14, patients lost 2.3% of their body weight, and by day 30, they lost 5.3%—even though they were eating better and getting help from dietitians. Patients who needed a feeding tube lost significantly more weight (7.2% vs. 3.9%)
  • What it means for you: If you or someone you know is having this surgery, doctors should monitor nutrition more carefully than just checking weight. This suggests patients may need extra nutritional support like supplements, and doctors should pay attention to how patients feel and what they’re actually eating, not just the numbers on the scale

The Research Details

This was a prospective observational study, which means researchers followed 25 patients forward in time after their bladder removal surgery and carefully tracked what happened. The patients were all treated using an enhanced recovery program (called ERAS), which is a special approach designed to help people recover faster from major surgery by managing pain better, getting them moving sooner, and feeding them earlier. Researchers measured how much food and protein patients ate, tracked their weight at different time points (day 1, day 14, and day 30), and noted which patients needed a nasogastric tube (a feeding tube that goes through the nose into the stomach). They also looked at whether patients had symptoms like nausea or trouble tolerating food.

This research approach is important because it captures real-world information about what actually happens to patients after this major surgery. Rather than just looking at weight (which can be misleading because of fluid changes), the researchers looked at multiple factors together. This helps doctors understand the true picture of how well patients are nourished and what signs they should watch for

This study has some strengths: it carefully tracked patients over time with specific measurements, and it was published in a respected nutrition journal. However, it’s a relatively small group (25 patients), so the findings may not apply equally to everyone. The study was observational, meaning researchers watched what happened rather than testing a specific treatment, so they can identify patterns but not prove cause-and-effect. The findings suggest areas where more research is needed

What the Results Show

During the first week after surgery, patients weren’t eating enough calories and protein to meet their body’s needs, even though they were being supported by dietitians. Interestingly, their weight didn’t change much during this first week—likely because their bodies were holding onto fluid from the surgery and hospital care. This is an important finding because it shows that stable weight doesn’t mean good nutrition. Starting around day 14, patients began losing weight noticeably. By day 30, patients had lost an average of 5.3% of their body weight—a statistically significant amount that suggests real nutritional loss. Even though patients’ eating improved over time and they received dietitian support, the weight loss continued. This suggests that the surgery itself causes nutritional challenges that go beyond just eating enough food.

A key secondary finding was that patients who needed a nasogastric tube (feeding tube through the nose) experienced much greater weight loss compared to those who didn’t need one. Those with feeding tubes lost 7.2% of their body weight by day 30, compared to 3.9% for those without tubes. This suggests that needing a feeding tube is a sign of more serious nutritional problems. The study also found that even with dietitian follow-up and improving food intake, weight loss persisted, indicating that the surgery’s effects on the body go beyond simple food intake issues

Previous research on major abdominal surgery has shown that weight loss after surgery is common, but this study adds important new information. It shows that for this specific surgery (bladder removal), the relationship between weight and nutrition is more complicated than previously thought. The finding that weight stability in the first week masks poor nutrition intake is particularly novel and challenges how doctors have traditionally monitored these patients. This research supports the growing understanding that nutrition after major surgery requires looking at multiple factors, not just weight

The study included only 25 patients, which is a relatively small number, so results may not apply to all patients having this surgery. The study was observational, meaning researchers couldn’t control all the variables or test a specific intervention—they just watched what happened. The study doesn’t explain why some patients lost more weight than others, or fully explain the mechanisms behind the nutritional challenges. Additionally, all patients received the same enhanced recovery program, so results might be different with other surgical approaches. The study was conducted at what appears to be a specialized center, so results might differ at other hospitals

The Bottom Line

Based on this research, patients undergoing bladder removal surgery should: (1) Expect that nutrition will be challenging after surgery and plan for close monitoring—moderate to high confidence; (2) Work with a dietitian who understands this specific surgery and can monitor actual food intake, not just weight—high confidence; (3) Consider that supplemental nutrition (like protein drinks or feeding support) may be necessary even if eating improves—moderate confidence; (4) Have doctors monitor for signs of nutritional problems beyond just checking weight, including fluid balance and body composition—moderate to high confidence

This research is most relevant for: patients scheduled for bladder removal surgery, their families and caregivers, surgeons and doctors who care for these patients, and dietitians working with post-surgical patients. People having other types of major abdominal surgery may also benefit from these insights. This research should NOT be used to self-diagnose nutrition problems or to avoid necessary surgery—rather, it should help patients and doctors have better conversations about nutrition support after surgery

Significant weight loss typically appears by day 14 after surgery and continues through day 30. Patients should expect nutrition challenges to persist even as their eating improves, suggesting that recovery takes longer than weight changes alone might indicate. Full nutritional recovery likely takes several weeks to months, depending on individual factors

Want to Apply This Research?

  • Track daily protein intake (in grams) and total calories consumed, along with weight measurements every 2-3 days. Also note any symptoms like nausea, feeling full quickly, or difficulty eating. This creates a complete picture beyond just weight changes
  • Users can set daily protein goals based on their dietitian’s recommendations and log meals to ensure they’re meeting targets. The app could send reminders to eat protein-rich foods and prompt users to note any eating difficulties or symptoms that might indicate nutritional problems
  • Long-term tracking should include: weekly weight measurements, daily food/protein logging for at least the first month, symptom tracking (nausea, appetite, digestion), and regular check-ins with a dietitian. Users should look for patterns in weight loss alongside eating patterns rather than relying on weight alone to assess nutrition status

This research describes nutritional challenges after bladder removal surgery in a specific group of 25 patients. It should not be used to make decisions about whether to have surgery—the benefits of necessary surgery far outweigh these nutritional challenges, which can be managed with proper support. If you are scheduled for this surgery or are recovering from it, discuss these findings with your surgical team and dietitian, who can create a personalized nutrition plan based on your individual needs. This information is educational and not a substitute for professional medical advice. Always consult with your healthcare provider before making changes to your nutrition or medical care.